Professional Employer Agreement Form

Instructions

A Professional Employer Organization (PEO) is required to file this Notice with the PEO's Workers' Compensation Insurance Carrier and the Commission when a PEO enters into a Professional Employer Agreement with a client in Arizona. This form must be completed in its entirety.  Failure to do so may cause a delay in processing.

Sign and Submit Form

Professional Employer Agreement Form

Printer-Friendly Form

PDF icon Claims_ProfessionalEmployerAgreement_Master.pdf