• Owner of the firm
• Employee on payroll
• Temporary, seasonal, union, or leased employee
• Co-employed per a professional employer organization agreement
• Independent contractor

• Worked at 1 location all of the time
• Worked equal time at 2 locations
• Worked unequal time at 2 or more locations — but at least 50% at 1 location
• None of the above

Use the address of their primary residence.

• Street address 1
• Street address 2Optional
• City
• State
  Zip code