Employer Services Downloadable Forms

This Registration form applies for both Unemployment Insurance and Workers' Compensation coverage. Make sure it is completely filled out, as incompleted forms will be returned, which will delay coverage. Please allow a minimum of 2 weeks for processing.

Or you may file online at: https://doe.state.wy.us/wyereg/ (Out of State Employers must complete the Joint Business Registration Form and the Out of State Employer Questionnaire.)

Amended Summary Report and Wage Listing (Excel file)

Amended Summary Report (PDF file)
Amended Wage Listing (PDF file)

Use this form when notifying the Division of reporting errors on already submitted Summary Reports or Wage Listings.

Out of State Employer Questionnaire

Use this form if you are a Non-Resident Employer. This form should be mailed to the Division with the Joint Employer Registration.

Power of Attorney

The Division must have this completed form in order to talk with anyone, other than the company, about the account (i.e.: payroll companies, accountants, etc.).

Certificate of Good Standing

Certificates must be requested in written form. This form can be filled out with the required information and mailed or faxed in. Or you may submit an online request.

Employer's Notice of Change

Use this document to report changes of address, name, telephone number; addition or change of federal ID number; change of account status; sale of a portion or all of the business. Complete all sections that apply by marking the appropriate choice and providing information as requested, date and sign below. Attach documentation as needed.

Instructions - WC Summary Report & Wage Listing

Instruction sheets for filling out the WC Summary Reports and Employee Wage listings.

Instructions - UI or UI/WC Summary Report & Wage Listing

You can also file your quartely Summary Reports electronically by using WIRE

Non-Resident Employers' Surety Bond (WC Only)

Bond Requirements
Bond Amounts
Bond Affidavit

This document must be submitted to the Division for those companies that are not based in Wyoming if wages are more than $10,000/month.

Affidavit for Corporate Officer Coverage (WC Only)

This document is no longer available online. Please contact the Division at 307-777-6763.

***You are NOT eligible for this coverage unless you have regular employees. ***

Important Information
Statewide Average Wage
Notice of Corporate Officer Changes

This affidavit must be completed in order for Corporate Officers to have coverage with Workers' Compensation.

No coverage will be allowed until after this affidavit is received.

Affidavit for Limited Liability Company Members Coverage (WC Only)

This Document is no longer available online. Please contact the Division at 307-777-6763.

*** You are NOT eligible for this coverage unless you have regular employees. ***

Important Information
Statewide Average Wage

This affidavit must be completed in order for LLC Members to have coverage with Workers' Compensation.

No coverage will be allowed until this affidavit is received.

Affidavit for Clerical Office Occupation Classification (WC Only)

Clerical support staff may be covered under a different class code than those of the main business. This form requests that classification. If a company does not have this class code, or if the employee do not meet the definitions of this class, then those wages must be reported under normal class code.

Affidavit for Outside Sales Classification (WC Only)

A worker predominantly engaged in sales or collections work away from the premises of the business, and whose work time spent at the business premises is engaged in sales or collections work which is necessary to their outside sales duties. Workers who are engaged in servicing equipment or delivery of the employer's product do not qualify for coverage under the Outside Sales occupation classification.

Remittance Coupon (WC Only)

Companies who wish to submit their Workers' Compensation premiums on a monthly rather than quarterly basis, may send them in with this form. The Quarterly reports must still be turned in when due. Please make sure the form is completely filled out to ensure proper identification. This form is also to make any type of payments that aren't being mailed in with a corresponding payroll report such as a Promissory Note or a penalty/interest payment.

UI or UI/WC Summary Report

If you need a replacement copy of this form, please contact the Division at 307-235-3217 or write to wcesweb@state.wy.us. If you need additional Wage Listings, you may request them.

Instructions for correctly filling out the form.

You can also file your quartely Summary Reports electronically by using WIRE.

WC Summary Report (WC Only)

If you need a replacement copy of this forms, please contact the Division at 307-777-6763 or write to wcesweb@state.wy.us.

Instructions for correctly filling out this form.

Drug-Free Workplace Premium Credit Program

Qualifying employers with a Drug and Alcohol Policy can receive a discount off their base rate. If approved, the discount will be effective the next quarter in which all necessary requirements are met. The application must be submitted each year for discount continuation. For additional information, please contact the Division at 307-777-6763.

Annual Application for the Certification of the Drug-Free Workplace Premium Credit Program