Fill and Sign the Self Employed Independent Contractor 497337208 Form

INDEPENDENT CONTRACTOR CONSIDERATION FOR HIRE FORM Name:       Telephone:       Fax:       Mailing Address:       City       State       Zip       Social Security Number       EIN (if applicable)       1. Are you a U.S. citizen or eligible to work in the U.S.? Y es N o 2. Have you ever submitted a proposal to work as an independent contractor before, or under a different name? Y es N o 3. Are you regularly engaged in the business or work for which you are applying? Y es N o 4. Are you prepared to accept payments at each stage of completion of the work? Y es N o 5. Will you work substantially out of your home? Y es N o 6. Will you perform the majority of the work on site or on the premises? Y es N o 7. Do you have a business license or professional designation? If yes please provide the number and/or type of license: _______________________________________ Y es N o 8. Do you pay your own employees? ( if no, skip to question 13.) Y es N o 9. If Yes, do you carry worker’s compensation insurance? Y es N o 10. Have you provided this service for any others within the last 12 months? If yes please provide references: ______________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Y es N o 11. Will you provide all the necessary tools and support to complete this job? Y es N o 12. Will you set your own priorities in terms of hours, time, supervision, training, etc? Y es N o 13. Will you be employed by anyone else while working on this job? Y es N o 14. If hired, do you plan to assign any part of this project to subcontractors? Y es N o 15. Are you classified as a non profit, 501(c)3? Y es N o 19. Please describe the services to be performed:_______________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ If the applicant has answered “No” to one or more of questions 1,3,4,7,8,or 9 then steps should be taken to assure that the hired individual or entity is in fact an independent contractor and will not be an employee, and that he/she will assume any and all liability for any problems or faulty workmanship. *NOTE THIS FORM IS ONLY TO BE USED AS A PROSECTUS FOR EVALUATING POTENTIAL CONTRACTORS- THIS IS NOT A CONTRACT. A LEGAL CONTRACT SHOULD ALWAYS BE SIGNED BY BOTH PARTIES UPON HIRING ANY INDEPENDENT CONTRACTORS. Copyright 2004 USLegalforms.com