Can this form be signed electronically?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided intent, consent, attribution, and record retention are met.

Do I need notarization for location changes?

Generally no. Notarization is rarely required for internal HR location records, though specific state or employer policies could require notarized affidavits for legal matters.

What happens if an employee moves to another state?

Update the form immediately. New work locations can change tax withholding, unemployment insurance coverage, and may require employer registration in the new state.

How should employers store completed forms?

Store records in a secure HRIS or document repository with tamper-evident audit logs, encryption in transit and at rest, and access controls consistent with privacy rules.

Are there privacy concerns with location data?

Yes. Location data may be sensitive; limit access, apply role-based permissions, and comply with HIPAA if forms include protected health information.

When should HR consult legal counsel?

Consult counsel for multi-state nexus questions, unusual remote-work arrangements, or when litigation, audits, or complex tax exposure arises.

Electronic Signature
Templates
HR
Employee Location of Workers Form

Employee Location of Workers Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYEE LOCATION OF WORKERS FORM

Purpose: This form documents the employee's principal work location(s), remote workspace details, business travel expectations, and related acknowledgments required for payroll, tax jurisdiction, health and safety, and operational compliance. Complete all sections accurately. Incorrect or incomplete information may affect payroll withholding, workers' compensation coverage, and eligibility for certain benefits.

Personal Information

Employee Name Home Address

Phone:

Email:

Position & Work Location

Job Title Department Reporting Manager

Employment Start Date:

Work Status (select all that apply): Remote On-site at company location Hybrid Field / Client sites

Primary Worksite Address (if different from home) Remote / Home Workspace Address (if applicable)

Time Zone for primary work location:

Work Schedule & Travel

Typical On-site Days (check all that apply): Mon Tue Wed Thu Fri Weekend as needed

Typical Daily Work Hours

Anticipated business travel: None Infrequent (less than 10% annually) Frequent (10% or more)

Equipment, Workspace & Safety

Employer-provided equipment (check all that apply): Laptop Desk Monitor Phone Other

If Other, describe equipment provided Workspace Hazards or Ergonomic Concerns

I affirm that my remote workspace complies with applicable safety and health standards and that I will promptly report any work-related injury or unsafe condition to my supervisor: Initial to acknowledge

Emergency Contact

Emergency Contact Name

Relationship:

Phone:

Employment History

Employer 1

Company Name

Title:

Dates Employed:

Primary Responsibilities Reason for Leaving

Employer 2

Company Name

Title:

Dates Employed:

Primary Responsibilities Reason for Leaving

Education

Highest Degree Institution

Graduation Date:

References

Reference 1

Name

Phone:

Email:

Relationship

Reference 2

Name

Phone:

Email:

Relationship

Reference 3

Name

Phone:

Email:

Relationship

Legal Disclosures & Authorizations

At-Will Employment: The employee's employment status is at-will unless a separate written agreement states otherwise. Either the employee or the employer may terminate the employment relationship at any time, with or without cause or notice, except as prohibited by law.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to protected characteristics, consistent with applicable law.

Location Data & Jurisdiction: The employee acknowledges that the employer may use the worksite information provided to determine payroll and tax jurisdiction, workers' compensation coverage, benefit eligibility, and other regulatory obligations. The employee must promptly notify Human Resources of any change to the work location. Failure to report a change may result in corrective payroll adjustments or other administrative action.

Consent to Contact and Background Checks: The employee authorizes the employer and its agents to contact listed references and prior employers and to obtain background checks, including verification of employment dates and duties, to the extent permitted by law. The employee further certifies that all statements on this form are true and complete.

Privacy Notice: Location, contact, and safety information will be maintained in HR records and used for legitimate business purposes. Access is limited to authorized personnel. The employee may raise questions or concerns about data collection and handling with Human Resources.

Employee Certification

Employee Name:

Signature:

Date:

What the Employee Location of Workers Form Is

The Employee Location of Workers Form records where an employee performs work for payroll, tax withholding, benefits, and workers' compensation purposes. It captures physical worksite addresses, remote-work jurisdictions, and effective dates so employers can determine state income tax withholding, unemployment insurance exposure, and payroll nexus. The form may also support workplace safety planning and benefit eligibility. Proper completion helps employers apply the correct state and local rules and creates an auditable record for compliance, payroll audits, and workforce reporting.

Why tracking employee work locations matters

Accurate location data reduces payroll errors, ensures correct tax withholding, and limits regulatory exposure for unemployment and workers' compensation. It supports payroll tax nexus calculations, remote-work policy enforcement, and benefits administration while creating a defensible audit trail.

Which teams and people complete this form

Employers and HR teams use this form to document employee work locations and associated dates before payroll processing.

Payroll administrators enter locations to calculate withholding and reporting
HR managers collect remote-work addresses for policy and benefits eligibility
Compliance officers track locations for state filings and audit evidence

Recordkeeping should be coordinated across HR, payroll, and legal to ensure consistency when employees change work locations.

Essential parts of a professional location form

A clear Employee Location of Workers Form balances concise fields with required legal data. Include signer identity, effective dates, complete addresses, work schedule, and acknowledgement of employer policies. Optional sections should capture primary vs secondary locations, temporary assignments, and remote-work certifications to support benefits and tax determinations.

Employee Identity

Full legal name, employee ID, and contact information to match payroll records and tax forms.

Work Location

Street address, city, state, and ZIP for each worksite to determine jurisdictional obligations.

Effective Dates

Start and end dates for each location assignment to apply correct withholding and coverage periods.

Work Arrangement

Status (remote, hybrid, on-site) and typical schedule to assess overtime and leave rules.

Employer Notes

Internal codes for department, cost center, or client site for payroll allocation and billing.

Acknowledgement

Employee signature and date confirming accuracy and understanding of employer policies.

Data elements employers must collect

Employee Name: Full legal name

Address: Street, city, state, ZIP

Work Status: Remote/hybrid/on-site

Effective Date: MM/DD/YYYY

Department: Cost center or division

Signature: Signed and dated

Step-by-step: completing the form

Follow these steps in order to complete and validate an Employee Location of Workers Form before payroll cutoff.

01

Collect Identity: Confirm full legal name and employee ID match HR file.
02

Enter Address: Record full street, city, state, ZIP for each worksite.
03

Set Dates: Use MM/DD/YYYY for start and end dates.
04

Sign & Save: Employee signs; employer retains copy for payroll.

How to configure an online completion workflow

Set up field routing, required status, and signer order to ensure valid and complete submissions.

Field	Configuration
Required Fields	Make name, address, effective date, and signature required
Signer Order	Employee signs first, HR reviews second
Notifications	Send confirmation to employee and payroll
Retention	Set automatic archiving per retention policy

Where completed forms should go

Route the completed form to payroll and HR systems and retain a copy in the personnel file.

Employee Copy: Employee receives signed PDF for records
HR Record: HR stores form in personnel file or HRIS
Payroll System: Payroll team updates withholding and reporting
Audit Archive: Store a tamper-evident copy for compliance

Sharing and eSubmission options

Choose secure delivery and signing methods that preserve identity, timestamp, and audit trail.

Email Link: Send a secure signing link to signer email
In-Person Kiosk: Use a kiosk or tablet for onsite signing
API Integration: Auto-route completed forms into HRIS

Ensure chosen methods meet ESIGN and UETA requirements for intent, consent, attribution, and retention.

Timing and payroll deadlines to observe

Coordinate form completion with payroll cycles and state registration deadlines to avoid misreporting and withholding errors.

Before Pay Cutoff:

Submit location changes before payroll run to apply correct withholding

State Registration:

Register for state withholding promptly when hiring in a new state

Quarterly Reporting:

Ensure locations match quarterly tax filings

I-9 Retention:

Keep related employment verification per I-9 rules

Audit Retention:

Maintain records to support audits and nexus reviews

Common mistakes to avoid

Using a P.O. box instead of a physical address causes jurisdiction errors
Failing to update effective dates when employees relocate causes withholding mismatches
Allowing unsigned or initial-only submissions that lack full signature intent
Not coordinating HR and payroll updates leading to double reporting or missed taxes

Regulatory risks and penalties from incorrect location data

Withholding Errors: Incorrect state withholding

Tax Penalties: Penalties under IRC §6721 for misfiled returns

I-9 Violations: Retention or completion fines per 8 CFR §274a.2

Workers' Comp: Coverage gaps and premium adjustments

Unemployment Fees: State UI chargebacks

Audit Exposure: Difficulties defending nexus decisions

eSignature vendor comparison for completing the form

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HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions

Answers to common questions about completing, signing, and storing an Employee Location of Workers Form.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided intent, consent, attribution, and record retention are met.
Do I need notarization for location changes?
Generally no. Notarization is rarely required for internal HR location records, though specific state or employer policies could require notarized affidavits for legal matters.
What happens if an employee moves to another state?
Update the form immediately. New work locations can change tax withholding, unemployment insurance coverage, and may require employer registration in the new state.
How should employers store completed forms?
Store records in a secure HRIS or document repository with tamper-evident audit logs, encryption in transit and at rest, and access controls consistent with privacy rules.
Are there privacy concerns with location data?
Yes. Location data may be sensitive; limit access, apply role-based permissions, and comply with HIPAA if forms include protected health information.
When should HR consult legal counsel?
Consult counsel for multi-state nexus questions, unusual remote-work arrangements, or when litigation, audits, or complex tax exposure arises.

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