You may, if you so choose, use the same email address in both fields presently designated for “Business Email Address” and “Personal Email Address”. However, please note that your business address may be released upon the request from a third party. Your personal email address will only be used for the purposes of communications from LABOR. In addition, if you wish to omit your business email address from the lists of licensees that from time to time LABOR makes available to third parties, you must notify us in writing or you can opt out by leaving your business email address blank. You may send your Opt out notice to email@example.com
Issued by the
I am not an employer required to provide employee coverage under the Workers Compensation Law.