Oregon Workers' Compensation Division

Worker Leasing License Application

Email to WorkerLeasing.WCD@oregon.gov

$2,050 due upon approval

• Signed releases for tax compliance verification:

  • Oregon Employment Department
  • Oregon Department of Revenue
  • Internal Revenue Service
• Written procedures that demonstrate how the applicant will ensure its clients provide adequate training, supervision, and instruction to meet the requirements of ORS chapter 654.
• A list of all states where the applicant operates as a worker leasing company. For each, identify license, registration, or certification numbers, expiration dates, and disclose any that are not in good standing.
• If no states are listed under the item above, attach a description of applicant’s experience, training, or education that demonstrates competency in providing worker leasing services. Experience, training, or education listed for each controlling person on will also be considered.
• Disclosure Addendum (if applicable)
• Controlling Person affidavit for each controlling person

Worker Leasing License Application - Renewal

Email to WorkerLeasing.WCD@oregon.gov

$2,050

Licenses expire biennially by the date of issuance. Renewal applications should be submitted at least 90 days prior to the expiration date.

• Signed releases for tax compliance verification:

  • Oregon Employment Department

  • Oregon Department of Revenue

  • Internal Revenue Service

• Written procedures that demonstrate how the applicant will ensure its clients provide adequate training, supervision, and instruction to meet the requirements of ORS chapter 654 (only if changes have been made)
• A list of all states where the applicant operates as a worker leasing company. For each, identify license, registration, or certification numbers, expiration dates, and disclose any that are not in good standing.
• If no states are listed under the item above, attach a description of applicant’s experience, training, or education that demonstrates competency in providing worker leasing services. Experience, training, or education listed for each controlling person on will also be considered.
• Disclosure Addendum (if applicable)
• Controlling Person affidavit for each controlling person
• Oregon client list including who provides coverage

Worker Leasing License Application - Limited

Email to WorkerLeasing.WCD@oregon.gov

$2,050 due upon approval

• Signed releases for tax compliance verification:

  • Oregon Employment Department
  • Oregon Department of Revenue
  • Internal Revenue Service
• Written procedures that demonstrate how the applicant will ensure its clients provide adequate training, supervision, and instruction to meet the requirements of ORS chapter 654.
• A copy of current licenses or registrations issued by other states.
• Client information

Worker Leasing License Application - Limited (Renewal)

Email to WorkerLeasing.WCD@oregon.gov

$2,050

Licenses expire biennially by the date of issuance. Renewal applications should be submitted at least 90 days prior to the expiration date.

• Signed releases for tax compliance verification:

  • Oregon Employment Department

  • Oregon Department of Revenue

  • Internal Revenue Service

• Written procedures that demonstrate how the applicant will ensure its clients provide adequate training, supervision, and instruction to meet the requirements of ORS chapter 654 (only if changes have been made)
• A copy of current licenses or registrations issued by other states.
• Client information