HR 1099 NEC Form

HR 1099 NEC FORM

Payer (Company) Information

Payee / Applicant (Independent Contractor)

Payee Name:

Tax Reporting Details

Tax Year:

Box 1 — Nonemployee compensation: $

Box 4 — Federal income tax withheld: $

Position & Engagement Information

Engagement Start Date:    End Date (if applicable):

Employment History (Most Recent)

Employment History (Previous)

Education

Graduation Date:

Professional References

Legal Disclosures & Authorizations

At-Will Acknowledgment: By signing this form the payee acknowledges and understands that engagement as an independent contractor is not a guarantee of continued work and that either party may terminate the engagement in accordance with any written agreement or, in the absence of such agreement, at will.

Equal Opportunity Statement: The payer affirms a policy of non-discrimination in the engagement of contractors. The payee acknowledges that all information provided is subject to the payer's non-discrimination policies.

Authorization to Contact and Background Checks: I authorize the payer and its agents to contact prior employers and references and to obtain background checks, verification of education, and other inquiries as necessary to verify the information provided. I understand that any offer or engagement may be conditioned on the results of those checks.

Applicant / Payee Certification

I certify that all information provided on this form, including taxpayer identification numbers and compensation information, is true, correct, and complete to the best of my knowledge. I acknowledge that providing false information may subject me to civil or criminal penalties. I further certify, under penalties of perjury, that:

1. the taxpayer identification number provided is correct;
2. I am not subject to backup withholding due to failure to report interest and dividends unless otherwise indicated;
3. I am a U.S. person (including a U.S. resident alien) for federal tax purposes unless a different status is indicated.

Certification: I certify the foregoing under penalty of perjury. I acknowledge that I have read and understand this certification.

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