Form C-6 - Application For Voluntary Election Of Coverage - Texas Workforce Comission
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1Texas Workforce Commission
PO Box 149080
Austin, Texas 78714-9080
TEXAS WORKFORCE COMMISSION
APPLICATION FOR VOLUNTARY ELECTION OF COVERAGE
(Submit in DUPLICATE)
Account Number
The undersigned employing unit hereby makes written election to cover the service specified herein according to the
provisions of the Texas Unemployment Compensation Act and hereby affirms that all information given in this application
is true and correct.
1.
Name of employing unit making this
election:
2.
Mailing address of this employing
unit:
Street
City
State
Zip Code
3.
Date this employing unit started business with one or more persons performing service for the employing unit in
Texas:
4.
If this employing unit has become a liable employer under the Federal Unemployment Tax Act, list each year for
which it has been so liable:
5. Place "X" in applicable block:
This under signed employing unit hereby elects, under Section 206.002 of the Texas Unemployment
Compensation Act to become an employer subject to the Act for a period not less than two (2) full calendar years
beginning with the date shown in Item 6, with respect to all services which are "employment" as defined in
Subchapter D of the Act.
This undersigned employing unit hereby elects, under Section 206.003 of the Texas Unemployment
Compensation Act, that all services which do not constitute "employment" as defined in the Act, performed by all
individuals in the employ of the employing unit in all of the employing unit's business establishments or places of
business in Texas shall be deemed to constitute employment for all the purposes of the Act; and this election is
made for a period not less than two (2) full calendar years beginning with the date shown in Item 6.
6. This election by the undersigned-employing unit is for the period beginning on the 1st day of January,
(Year).
It is understood and agreed that at the end of the two year period above specified, or at the end of any calendar year
subsequent thereto, the undersigned may, by filing a written request with the Texas Workforce Commission on or
before March 31 of the succeeding year, withdraw this election.
Date:
Signed by:
This election must be signed by the owner, a
partner, or a corporate officer, or by a person whose
Title:
signature is authorized in accordance with Texas
Workforce Commission Rule 8.
This application approved by the Texas Workforce Commission on
This application will be effective to establish
liability only when it is approved.
Director Tax Department
TEXAS WORKFORCE COMMISSION
Individuals may receive, review, and correct information TWC collects about the individual by
th
emailing to
open.records@twc.state.tx.us
or writing to TWC Open Records, 101 East 15
St , Room 266, Austin, TX, 78778-0001.
Form C-6 (0901)
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