Nevada Department of Business and Industry

PEO Application Form

$500

• List of all owners, partners, and/or corporate officers
• A list of client companies under contract with the PEO
• Declaration Page signed by each officer as listed in the registration application
• Proof of Nevada State Business License
• Completed PEO Domicile & Contact Information Sheet
• Employee Leasing Company (PEO) Insurance Certification Form
• Proof of industrial insurance coverage as required by the Nevada Industrial Insurance and Occupational Diseases Acts (Chapters 616A to 616D, inclusive, and Chapter 617 of the Nevada Revised Statutes) Attach copies of the Certificates of Insurance or Declaration Pages for Nevada leased employees at each client company and proof of coverage for your internal PEO staff residing in Nevada
• Proof of Workers’ Compensation Insurance for each Client listed in Section C of the application. The certificates must be in the same order as the list of clients
• Proof of Workers’ Compensation Insurance for internal staff
• Nevada Employment Security Dept (DETR) Notice of Contribution or Wage Report for each client listed in Section C of the application. (Confirmation from DETR showing that an account number has been assigned may be submitted for new companies.) The forms must be in the same order as the list of clients.
• Financial Statement and Proof of Working Capital

PEO Application Form (Renewal)

$500

Annually by the date of issuance.

• List of all owners, partners, and/or corporate officers
• A list of client companies under contract with the PEO
• Declaration Page signed by each officer as listed in the registration application
• Proof of Nevada State Business License
• Completed PEO Domicile & Contact Information Sheet
• Employee Leasing Company (PEO) Insurance Certification Form
• Proof of industrial insurance coverage as required by the Nevada Industrial Insurance and Occupational Diseases Acts (Chapters 616A to 616D, inclusive, and Chapter 617 of the Nevada Revised Statutes) Attach copies of the Certificates of Insurance or Declaration Pages for Nevada leased employees at each client company and proof of coverage for your internal PEO staff residing in Nevada
• Proof of Workers’ Compensation Insurance for each Client listed in Section C of the application. The certificates must be in the same order as the list of clients
• Proof of Workers’ Compensation Insurance for internal staff
• Nevada Employment Security Dept (DETR) Notice of Contribution or Wage Report for each client listed in Section C of the application. (Confirmation from DETR showing that an account number has been assigned may be submitted for new companies.) The forms must be in the same order as the list of clients.
• Financial Statement and Proof of Working Capital

PEO Application Form (Amendment)

$0

Within 30 days after a change occurs.

NRS 616B.679

Applicants must submit an updated application for any change in the information reported on the initial application.