Verification of Non-Employment

There are two reasons to complete a Verification of Non-Employment form:

  • Your business is applying for a North Dakota contractor’s license, you are not required to secure workers’ compensation coverage with WSI at this time, and you would like WSI to send a letter indicating this to the North Dakota Secretary of State office.
  • Your business is not required to secure workers’ compensation coverage with WSI and you would like WSI to provide you with a letter indicating that WSI coverage is not required at this time

If you neither employ nor anticipate employing anyone within the state of North Dakota in the future, and do not meet the tests of significant contact with North Dakota, you are not required to apply for workers’ compensation insurance. However, before WSI will send a letter of good standing to the Secretary of State, you must complete a Verification of Non-Employment form. When the completed form is received and reviewed by WSI, we will provide a letter of good standing to the Secretary of State.

If you have an active account with WSI and are looking to secure or renew a North Dakota contractor's license, you may upload your current WSI Certificate of Payment via the North Dakota Secretary of State website.

SIGNIFICANT CONTACTS

If you hire workers in this state to work in this state, WSI coverage is mandatory. If you bring out-of-state employees into North Dakota and this exposure results in significant contacts with North Dakota, WSI coverage is mandatory.

Significant contacts are defined as:

  • Any employee earns or would have been expected to earn 25% or more of the employee’s gross annual wage or income from that employer for services rendered North Dakota; or
  • 25% of the employer's gross annual payroll is payable to employees for services rendered in North Dakota
  • An employer hires an employee in North Dakota for work in North Dakota. If you come into North Dakota and hire workers here, WSI coverage is required
VERIFICATION OF NON-EMPLOYMENT FORM ACKNOWLEDGEMENT

Your signature on the Verification of Non-Employment form acknowledges:

  • You do not have, nor do you intend to have employees
  • You will secure proper coverage in the event you hire
  • You have read and understand the WSI Fraud Warning
  • If you are an out of state employer, you have not hired workers in this state to work in this state and you do not have significant contacts with North Dakota