Fillable Independent Contractor Pre-Hire Worksheet Authorization Form (Page 2 of 2) in pdf

Independent Contractor Pre-Hire Worksheet Authorization Form Page 2

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Relationship of Parties: Intent of parties concerning status and control of worker

Employee

Contractor

Factor

Description

(Yes)

(No)

(8)Right to

Could the university terminate the worker at any time without incurring

Terminate

liability? (Most independent contractor agreements require at least a 30

days’ notice for early termination.)

(9)Regular

Is the work to be performed part of the regular business of the university,

Business

such as teaching or research? (In most cases, such duties would be

Activity

performed by an employee.)

(10)Written

Will a written contract not be executed describing the worker as an

Contract

independent contractor? (Absent such a contract or purchase order,

employee status is normally presumed.)

(11)Employee

Will the worker receive any employee benefits?

Benefits

(12)

Is the university entitled to withhold payment for unsatisfactory work?

Withholding of

(Most independent contractor agreements allow this, while employer-

Payment

employee relationships do not.)

TOTALS

Total all “YES” or “NO” responses

SCOPE OF WORK

Duties to be performed (Use another piece of paper if necessary):

Start Date: ___________________________

End Date: ___________________________

Amount to be paid: ___________________________

Chartfield:___________________________

SPECIAL INSTRUCTIONS

RECOMMENDATION (BY DEPARTMENT)

Hire worker as an employee

Hire worker as an independent contractor

DEPARTMENT AUTHORIZATION BY APPROPRIATE ADMINISTRATOR

Prepared By

Dept. Chair Signature _________________________________ Date_______________________________

Print Name

__________________________________________________________________

ASM Signature _______________________________________ Date_______________________________

Print Name ____Terie Bostic______________________________________________________ (Level 4)

DETERMINATION BY HUMAN RESOURCES MANAGEMENT

Granted

Denied

Director, Human Resources Service Group ___________________________________________

Independent Contractor Pre-Hire Worksheet Authorization Form Page 2

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