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Request Number is 123456
Please download the Joint Election Signature form by clicking the "Download Signature Document" button below.
After you download the Joint Election Signature, print the form, and then email, fax, or deliver in person to the owners or members for signature. Once the document is signed, you should review it to ensure the document is signed correctly. Any incomplete or improperly signed document may delay the processing of the Request. Upon receipt of all necessary signatures, please upload the form using "Complete and attach signed Joint Election" option to finish the submission. Do not select this option until you have all signatures.
Joint Election
  • Type Of Request
  • Attach Signed Joint Election
    • Requester Information
    • Employer Information
    • Mailing Address Information
    • Coverage and Signature Details
Type Of Request
Select the type of request to proceed further.
Select whether this is a new Joint Election or you are completing the previously submitted Joint Election.
The Joint Election requires signature on the form.
Start new Joint Election Complete and attach signed Joint Election
Attach Signed Joint Election Form
Attach the signed joint election form.
Joint Election Request Number
*Required
Upload Signed Joint Election Document
*Required
Requester Information
Provide the requester information.
Pursuant to the provisions of § 9-204 of the Labor and Employment Article ("LE") of the Annotated Code of Maryland, the employer of an individual who otherwise would not be a covered employee may elect to make the Individual a covered employee by filing a joint election with the commission. If an individual is not a covered employee pursuant to LE § 9-223(c) of this subtitle, the employer of that individual may not make an election under this section, if prohibited by federal law.
To exercise this option, both the individual electing to become a covered employee and the employer must provide electronic signature for this activity.
Name
*Required
Email
*Required
Title or Company Position
*Required
Employer Information
Provide the employer information.
Employer Name
*Required
Company Name(if applicable)
Address
*Required
City
*Required
State
*Required
Postal Code
*Required
Phone
*Required
Mailing Address Information
Provide the mailing address.
Mailing Address
*Required
City
*Required
State
*Required
Postal Code
*Required
Employee Coverage Details
Provide the employee coverage information.

Before you begin: You must first generate the Joint Election Signature form by selecting the "Save & Generate Document" button below.
After you generate the Joint Election Signature form, print the form, and then email, fax or deliver in person to the other parties for signature. Once the document is signed, you should review it to ensure all document is signed correctly. Any incomplete or improperly signed document may delay the processing of the Request. Upon receipt of all necessary signatures, please upload the form below. Do not select this option until you have all signatures.
Please make sure you upload Signed document in .pdf format using the request number.

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