Independent Contractor Application – Fill Out and Use This PDF

Independent Contractor Application – Fill Out and Use This PDF

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Independent Contractor Application – Fill Out and Use This PDF

The Independent Contractor Application form is a comprehensive document designed to collect essential information from individuals seeking to engage in professional services as independent contractors. This form covers a wide range of details, including personal background, professional references, previous positions, current contractual obligations, and eligibility for work in the U.S., ensuring a thorough understanding of the applicant’s qualifications and legal status. Click the button below to start filling out your application form and take a step towards becoming an independent contractor.

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Independent Contractor Application PDF Details

At the heart of every independent contractor's professional journey lies the pivotal moment of completing an Independent Contractor Application form. This comprehensive document not only serves as a vital introduction of the contractor to potential hiring entities but also meticulously outlines the foundational details crucial for establishing a clear and legally sound working relationship. From capturing basic background information, such as the applicant's name, contact details, and type of entity, to more intricate aspects like the detailed description of the primary business, services offered, and anticipated rates, the form encompasses a broad spectrum of data. Furthermore, it delves into the contractor's professional history, existing contractual obligations, and importantly, their legal eligibility to work within the U.S., providing a robust framework for assessing the contractor's qualifications and readiness. This form also touches upon critical compliance and verification sections, requiring signatures for accuracy certification, thereby underscoring the importance of honesty and integrity in the process. The inclusion of sections addressing the contractor's understanding of their tax obligations and the nature of their independent relationship with the hiring entity reaffirms the non-employment nature of the engagement, highlighting the unique responsibilities and conditions that govern the independent contractor's role.

Question	Answer
Form Name	Independent Contractor Application
Form Length	15 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	3 min 45 sec
Other names	contractor application form, 31st, Wyoming, Cosmetology

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FOR OFFICIAL USE ONLY

Date Received:_______/_______/__________

Reviewed by:___________________________________________

Comments:_____________________________________________

________________________________________________________

INDEPENDENT CONTRACTOR APPLICATION

Applications are considered for all independent contractors, and contractors are treated during the agreement, without regard to race, color, religion, sex, national origin, age, disability, or any other prohibited basis of discrimination as provided under applicable state and federal law.

Position(s) Applying For:__________________________________________________________________________________________

BACKGROUND INFORMATION

Name:__________________________________________________________________________________________________________

Street Address:__________________________________________________________________________________________________

City:________________________________ State:_______________________________ Zip:_________________________________

Phone:______________________________ Fax:________________________________ Email:_______________________________

Type of Entity (e.g., individual, corporation, partnership, etc):________________________________________________________________

Description of Primary Business:___________________________________________________________________________________

SIC (if business)_______________________________ SSN (if individual)_____________________________ EIN (if business)_______________________________

Products/Services Offered (check all that apply):
□ Consulting	□ Professional	□ Other

CONTRACTING REQUEST

Anticipated Rates: $_____________________________________________________________________________________________

Hours Available per Week:_______________________________________________________________________________________

What is the earliest date you can begin work?:___________________________________________________________________

PROFESSIONAL REFERENCES

Name:	Company:	Position:	Contact Info:
___________________________	___________________________	___________________________	___________________________
___________________________	___________________________	___________________________	___________________________
___________________________	___________________________	___________________________	___________________________

PREVIOUS POSITIONS (Please begin with most recent)

Company:__________________________ Phone:______________________________ Contact:____________________________

Address:________________________________________________________________________________________________________

Employment Dates:	Pay or Salary:	Reason for leaving:	Position & Duties
From_______________________	Start_______________________	___________________________	___________________________
To_ ________________________	Final_______________________	___________________________	___________________________

Company:__________________________ Phone:______________________________ Contact:____________________________

Address:________________________________________________________________________________________________________

Employment Dates:	Pay or Salary:	Reason for leaving:	Position & Duties
From_______________________	Start_______________________	___________________________	___________________________
To_ ________________________	Final_______________________	___________________________	___________________________

Company:__________________________ Phone:______________________________ Contact:____________________________

Address:________________________________________________________________________________________________________

Employment Dates:	Pay or Salary:	Reason for leaving:	Position & Duties
From_______________________	Start_______________________	___________________________	___________________________
To_ ________________________	Final_______________________	___________________________	___________________________

EXISTING CONTRACTUAL RELATIONSHIPS (Please list all current independent contractor relationships)

Company:______________________________________________________________________________________________________

Address:____________________________	Obligations:_________________________	Industry Type:_ ______________________
____________________________________	____________________________________	____________________________________
Phone:______________________________	Effective Date:______________________	Monthly Hours Worked:______________
Contact:____________________________	End of Term:________________________	____________________________________

Company:______________________________________________________________________________________________________

Address:____________________________	Obligations:_________________________	Industry Type:_ ______________________
____________________________________	____________________________________	____________________________________
Phone:______________________________	Effective Date:______________________	Monthly Hours Worked:______________
Contact:____________________________	End of Term:________________________	____________________________________
Company:______________________________________________________________________________________________________
Address:____________________________	Obligations:_________________________	Industry Type:_ ______________________
____________________________________	____________________________________	____________________________________
Phone:______________________________	Effective Date:______________________	Monthly Hours Worked:______________
Contact:____________________________	End of Term:________________________	____________________________________

ADDITIONAL INFORMATION

Are you legally eligible for work in the U.S.A.?	□	Yes (verification required)	□	No
Have you ever contracted with HHA before?	□	Yes	□	No

If yes, when? (Please attach previous contract application)_________________________________________________________________

Do you have liability and/or malpractice insurance?

□ Yes

□ No

If yes, please attach proof of insurance to application.

Do you agree to obtain any and all licenses that may be
required to do business as an independent contractor or
self-employed person?	□	Yes	□	No
Do you understand that as an independent contractor,
you would not be eligible for unemployment benefits at
the end of any contract with HHA?	□	Yes	□	No
Do you understand that as an independent contractor,
you would be responsible for payment of any and all
state and/or federal income taxes, Social Security,
self-employment taxes, unemployment taxes, and
payroll taxes and you will receive a form 1099 for
service provided to HHA by you?	□	Yes	□	No

SIGNATURE/CERTIFICATION

I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for immediate denial of my appointment or removal from consideration or, if I have entered into a contract with this company, for immediate termination of that contract. I authorize HHA to make any necessary inquiries and investigations into my education, references, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to HHA by any of the schools, services, or employers listed on this application.

I also hereby release from liability HHA and its representatives for seeking, gathering, and using such information to make decisions concerning my status as an independent contractor for HHA and all other persons or organizations for providing such information.

THIS IS NOT AN APPLICATION FOR EMPLOYMENT. I understand and agree that if this application is accepted, my status will be that of an independent contractor and as such, I will be solely responsible for all tax liabilities pertaining to monies received in the course of services I perform.

If I am retained by HHA as an independent contractor I will:

•Not be entitled to workers compensation benefits.

•Not be entitled to unemployment insurance benefits unless unemployment coverage is provided by me or some other entity.

•Be obligated to pay federal and state income tax on any moneys paid pursuant to the contract.

•Be required to provide professional and liability insurance.

I represent and warrant that I have read and fully understand the foregoing, and that I seek to become and independent contractor under these conditions.

Signature:_______________________________________________________________________Date:_______/_______/__________

	Employment Eligibility Verification	USCIS
	Department of Homeland Security	Form I-9
	Department of Homeland Security	OMB No. 1615-0047
	U.S. Citizenship and Immigration Services	OMB No. 1615-0047
	U.S. Citizenship and Immigration Services	Expires 08/31/2019

►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

Other Last Names Used (if any)

Address (Street Number and Name)

Apt. Number

City or Town

State

ZIP Code

Date of Birth (mm/dd/yyyy)

U.S. Social Security Number

- -

Employee's E-mail Address

Employee's Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1.	A citizen of the United States

2.	A noncitizen national of the United States (See instructions)

3.	A lawful permanent resident	(Alien Registration Number/USCIS Number):


4.	An alien authorized to work	until (expiration date, if applicable, mm/dd/yyyy):

Some aliens may write "N/A" in the expiration date field. (See instructions)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:

An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1.Alien Registration Number/USCIS Number:

2.Form I-94 Admission Number:

3.Foreign Passport Number: Country of Issuance:

QR Code - Section 1

Do Not Write In This Space

Signature of Employee	Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one):

I did not use a preparer or translator.

A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Employer Completes Next Page

Form I-9 07/17/17 N

Page 1 of 3

How to Edit Independent Contractor Application Online for Free

This PDF editor was created with the purpose of making it as simple and intuitive as it can be. These steps can certainly make filling in the renewals quick and easy.

Step 1: The first thing would be to press the orange "Get Form Now" button.

Step 2: At this point, you can alter the renewals. Our multifunctional toolbar permits you to add, eliminate, modify, highlight, and perform other commands to the content material and areas within the form.

In order to complete the form, enter the details the platform will request you to for each of the following sections:

Within the field City, State, Zip, Phone, Fax, Email, Type of Entity eg individual, Description of Primary Business, SIC if business, SSN if individual EIN if business, ProductsServices Offered check all, Consulting, Professional, Other, and CONTRACTING REQUEST write down the details which the application requests you to do.

Outline the crucial information in the segment.

The PREVIOUS POSITIONS Please begin, Company Phone Contact, Address, Employment Dates, Pay or Salary, Reason for leaving, Position Duties, From, Start, Final, Company Phone Contact, Address, Employment Dates, Pay or Salary, and Reason for leaving area will be the place to insert the rights and obligations of either side.

Finalize by reviewing the following sections and filling them out accordingly: Company Phone Contact, Address, Employment Dates, Pay or Salary, Reason for leaving, Position Duties, From, Start, Final, EXISTING CONTRACTUAL RELATIONSHIPS, Company, Address, Obligations, Industry Type, and Phone.

Step 3: Press "Done". You can now upload the PDF document.

Step 4: In order to prevent any type of troubles down the road, you should prepare at the very least a few duplicates of the document.

Signature of Preparer or Translator

Today's Date (mm/dd/yyyy)

Last Name (Family Name)

First Name (Given Name)

Address (Street Number and Name)

City or Town