Determination of Independent Contractor Status for:
(Form is to be completed by Bradley University personnel)
Individual's Full Name (printed)
Individuals who perform services for any Bradley University (University) department/unit/center are presumed to be employees of the University unless the relationship satisfies
IRS standards for Independent Contractor. The questions below will determine whether the individual satisfies IRS standards for Independent Contractor status.
Is the individual a U.S. Citizen? Yes____ No
If “Yes”, proceed to Part A of this form. If “No”, please contact the Payroll Department and Do Not
complete this form at this time.
CRITERIA FOR DETERMINING INDEPENDENT CONTRACTOR STATUS
PART A (Answer all five of the following questions.)
1. Is the individual currently employed by Bradley University? Yes No
2. Does this individual provide essentially the same service as an employee of the University? Yes No
3. Has this individual previously been paid as a University employee to perform essentially
these same tasks? Yes No
4. Is it currently expected that the University will hire this individual as an employee immediately
following the termination of the service provided? Yes No
5. Will this individual supervise or direct University employees as part of the service provided? Yes No
PART B (The individual belongs in one of the following categories. Determine the appropriate category and answer all questions therein.)
1. Teacher/Lecturer/Instructor (If N/A, please complete Part B2)
a. Does this individual provide their services exclusively to Bradley University? Yes No
b. Will this individual teach/lecture/instruct for at least one semester? Yes No
c. Is the individual responsible for administering the course (i.e. selecting course materials;
establishing course objectives, preparing & grading tests; etc.)? Yes No
d. Will this individual perform the services on a continuing basis as part of the department or
centers ongoing operations? Yes No.
e. Is the individual a guest lecturer AND has the individual been compensated
by the University more than two times in the last 12 months? Yes No
2. Individuals not covered under Part B1
a. Does this individual provide their services exclusively to Bradley University? Yes No .
b. Will the department/unit/center provide the individual with specific instructions regarding
performance of required work as opposed to relying upon individual’s expertise? Yes No
c. Will the department/unit/center determine and/or set the individuals daily work schedule? Yes No
d. Will this individual perform the services on a continuing basis as part of the department,
centers or units ongoing operations? Yes No
Department/Unit/Center Certification Based upon the responses to the questions contained in Part A and Part B above, the individual has
been determined to be an independent contractor.
I understand that should the IRS later determine that Independent Contractor status was incorrect, and that this individual should have been
classified as an Employee, the University may be subject to penalties.
Approved By (Signature) Date
Name and Title of Individual Approving this Form Originating Department/Center/Unit
If the individual is determined to be an independent contractor, the reverse side of this form must be completed.
If the answer to any one of the above questions is yes, then for tax purposes, the individual is to be treated as an employee. There is no need to
proceed to Part B. If all the answers to the above questions were no, proceed to Part B.
If the answer to any one of the questions in Part B1 or Part B2 is yes, then for tax purposes, the individual is to be treated as an employee. There is
no need to complete the remainder of this form. If all the answers to the questions in Part B1 or B2 were no, the department/unit/center certification
must be completed.