Independent Contractor Form
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1
2INDEPENDENT CONTRACTOR FORM
PART I -- To be completed by prospective independent contractor (i.e., the individual providing a service)
Are you a citizen of the United States? ___________
If the answer is “NO”, what visa type do you have? ____________
If you are not a US Citizen or do not have Permanent Residency you need to fill out additional paperwork. Please contact
The University of Hartford Financial Accounting Services Department.
Name_________________________________________________________
Telephone _______________________
Fax________________________
E-Mail _____________________________________
Home Mailing Address ___________________________________________________________________________________________
Describe the Services to be provided: _______________________________________________________________________________
Term of Service (specific dates): ______________________________
Do you have a relative employed at the University? ________
If “Yes” please provide their name and department: _________________________________________________________
Section I – Relationship with the University
Yes
No
A.
Do you currently work for the University as an employee?
B.
Has the University extended you an offer of employment?
C. Have you worked as an employee of the University during the 12 months prior to the date of this contract?
If the answer is “NO” to all questions, proceed to Section II.
If the answer is “YES” to any of the questions, the individual should be classified as an employee and paid via payroll.
Section II – Classification Guidelines (Complete A, B and C.)
A. Guest Speaker
Yes
No
1.
Have you been invited, as a guest speaker, to lecture in a seminar, colloquium, class, etc?
If the answer to question 1 is “Yes”, proceed to question 2 through 5. If the answer to question 1 is “No”, proceed to Item B.
2.
Have you been engaged by the University more than 5 times in the past 12 months?
3.
Will the University provide you course materials and tools?
4.
Will the University reimburse you for course related expenses?
5.
Will the department provide specific instructions regarding performance of the required work rather than
relying on your expertise?
If the answer is “YES” to any of the above questions 2 through 5, the individual should be classified as an employee and paid
via payroll. If the answer is “No” to all questions 2 through 5, treat the services performed as honoraria. An Order for Check
form should be used to process payment for service rendered through Accounts Payable.
B. Researcher
Yes
No
1.
Will you be performing research services to the University of Hartford?
If the answer to question 1 is “Yes”, proceed to questions 2 through 5. If the answer to question 1 is “No”, proceed to Item C.
2.
Will you perform research under the supervision of a University professor or employee?
If the answer to question 2 is “Yes”, treat the individual as an employee. If the answer to question 2 is “No”, proceed to
questions 3 through 5.
3.
Will you serve in an advisory or consulting capacity with a University Professor or employee?
4.
Have you provided the same or similar services to other unrelated entities in the last 12 months?
5.
Will your period of service be completed within a finite time frame?
6.
Will the University reimburse you for any expenses?
7.
Will the University provide you with any tools or supplies?
If the answer to questions 3, 4, and 5 is “Yes”, treat the individual as an Independent Contractor. Otherwise the individual
should be paid as an employee via payroll.
C. Individual not covered under Items A and B
Yes
No
1.
Have you provided the same or similar services to other unrelated entities or to the general public as a
trade or business during the last 12 months?
2.
Will your period of service be performed within a finite time frame?
3.
Will the department provide specific instructions regarding performance of the required work rather than
relying on your expertise?
4.
Will the University set the number of hours and/or days of the work week that you are required to work, as
opposed to you setting your own work schedule?
5.
Will the University reimburse you for any expenses?
6.
Will the University provide you with any tools or supplies?
If the answer to question 1 and 2 is “Yes” and 3, and 4 is “No”, treat the individual as an Independent Contractor.
Otherwise the individual should be paid as an employee via payroll.
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