PART D EMPLOYER CERTIFICATION
This application must be submitted 60 days prior to the start date of the seasonal operation and must be signed
by the owner, a partner, a corporate officer, or duly authorized employer representative.
I certify to the following:
1. I certify that the information provided on this application is correct to the best of my knowledge.
2. If this application is approved, I will post a copy of the Certification as a Seasonal Employer for inspection by my
employees and I will issue a copy of the Certification as a Seasonal Employer to all applicants for seasonal employment.
3. If this application is approved, I will issue a copy of the Notice to Employees of Certification as a Seasonal Employer to all
seasonal employees.
4. I will report seasonal wages paid to seasonal employees to the Department of Unemployment Assistance on a quarterly
basis.
5. If this application is denied, I will post a copy of the denial notice for inspection by my employees.
Print Name: ____________________________________________ Title: _______________________________________
Signature: _____________________________________________ Date: _______________________________________
Telephone Number: _________________________________________________________________________________
Submit this request to: Massachusetts Department of Unemployment Assistance
19 Staniford Street, Revenue
Boston, MA 02114
You may also email this application to UIEmployerHelp@massmail.state.ma.us with a subject of Certified Seasonal Employer
Application.
If you have any questions, please call (617) 626-6350.
Form 1872 Rev. 1-17
