Employment IC Waiver

EMPLOYMENT INDEPENDENT CONTRACTOR WAIVER

Company Name:    Contractor Name:

Effective Date:

RECITALS

This Independent Contractor Waiver (the Waiver) is entered into by and between the Company named above and the Contractor named above. The parties acknowledge that Contractor will provide services to Company as an independent contractor and not as an employee. The Contractor expressly acknowledges the terms set forth herein and agrees to waive certain claims and to assume specified obligations as a condition of the engagement.

DEFINITIONS

For purposes of this Waiver: "Independent Contractor" means that the Contractor retains control over the means and manner of performing services, supplies the necessary tools, is responsible for taxes and insurance, and is not eligible for Company employee benefits.

CONTRACTOR ACKNOWLEDGMENTS

Contractor acknowledges the following and initials each item to confirm:

Initials:    Contractor affirms that Contractor will perform services as an independent contractor and not as an employee of Company.

Initials:    Contractor understands Contractor is not entitled to employee benefits including health insurance, retirement, paid leave, or workers' compensation through Company.

Initials:    Contractor is responsible for all federal, state and local taxes, and will not look to Company for tax withholding.

WAIVER AND RELEASE

In consideration of the engagement, Contractor hereby irrevocably and unconditionally releases, waives and forever discharges Company and its officers, directors, employees, agents and affiliates from any and all claims, causes of action, liabilities, demands or damages arising from or related to any assertion that Contractor is or should be adjudicated an employee of Company, including but not limited to claims for wages, overtime, benefits, unemployment insurance, payroll taxes, workers' compensation, and similar statutory or common law claims.

Contractor expressly acknowledges that this Waiver includes unknown claims which may exist as of the Effective Date and understands that this release is intended to be interpreted broadly.

TAXES, INSURANCE AND INDEMNIFICATION

Contractor will maintain, at Contractor's expense, any required insurance and will be responsible for all taxes, contributions and levies (including self-employment tax). Contractor shall indemnify, defend and hold harmless Company from any liability, loss or expense (including attorneys' fees) arising out of Contractor's failure to pay taxes or to maintain required insurance.

CONTRACTOR REPRESENTATIONS

Contractor represents and warrants that Contractor is engaged in an independent trade, occupation, or business, has the requisite skill to perform the services, and will control the manner and means by which services are performed. Contractor further represents that Contractor may accept work from other parties during the term of this engagement.

PERSONAL INFORMATION

POSITION / ENGAGEMENT

Anticipated Start Date:    Compensation Rate:    Engagement Type: Project-based    Ongoing/Retainer

EMPLOYMENT / CONTRACT HISTORY

Title:    Dates Employed: From To

Title:    Dates Employed: From To

EDUCATION

Graduation Date:

REFERENCES

Phone:    Email:

Phone:    Email:

Phone:    Email:

LEGAL DISCLOSURES

At-Will Statement: Where applicable, the Company and Contractor acknowledge that either party may terminate engagement in accordance with applicable law. Contractor acknowledges that independent contractor status is intended and that no implication of employment is created by the provision of services under this Waiver.

Equal Opportunity Statement: Company is an equal opportunity entity. Contractor acknowledges that this Waiver does not alter Company's obligations under applicable nondiscrimination laws except as expressly provided.

BACKGROUND CHECKS & AUTHORIZATIONS

By checking the box below, Contractor authorizes Company to verify the information provided in this form, to contact prior employers and references, and to obtain background checks or other screening reports as permitted by law.

I authorize the Company to obtain background, reference, and employment verification checks.

APPLICANT CERTIFICATION

I certify that all information provided in this Waiver, and accompanying documents, is true and complete to the best of my knowledge. I understand that any material misrepresentation or omission may result in rescission of this Waiver or other remedies available to Company. I further acknowledge that I have had the opportunity to seek independent legal counsel prior to signing.

Contractor Certification Initials:

MISCELLANEOUS

Governing Law:    Severability: If any provision of this Waiver is found unenforceable, the remainder shall remain in full force and effect.

Entire Agreement: This Waiver contains the entire agreement between the parties relating to the subject matter hereof and supersedes all prior agreements and understandings. Any amendment must be in writing and signed by Contractor and an authorized representative of Company.

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