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.

E-sign Electronic Submission Form

Printable Form

Claims_ProfessionalEmployerAgreement_Master.pdf

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