Fillable INSTRUCTIONS FOR COMPLETING CHECKLIST Prior To Engagement, The (Umpqua Community College)

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INSTRUCTIONS FOR COMPLETING CHECKLIST Prior To Engagement, The (Umpqua Community College)

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Revised 08/20/2012
INSTRUCTIONS FOR COMPLETING CHECKLIST
First name Last Name
Address
Federal Id#: Telephone
YES NO
UMPQUA COMMUNITY COLLEGE
Independent Contractor Checklist
B.4 Will the individual be expected to or required to perform full-time work hours at the college or facilities
operated by the college?
B.5 Will the individual be expected to comply with instructions or directions from college staff to where, how,
and when the work is to be performed?
B.6 Is the individual required to receive training from college staff to enable the individual to perform the
work?
B.7 Will the college be responsible for hiring, supervising, and compensating workers who will substantially
assist the individual performing the requested services?
B.8 Will the individual be paid for services based on an hourly, weekly, or monthly basis?
B.9 Will the college provide a significant amount of tools, equipment, or materials needed by the individual to
perform the services?
B.10 Will the individual be subject to termination by the college for reasons other than non-performance of
the service agreement?
B.11 Can the individual terminate the service agreement with the college without incurring any liability for a
failure to perform services?
B.3 Will the individual be required to devote essentially full-time hours to perform services for the college
preventing the individual from providing services to other clients during the contract period?
Prior to engagement, the responsible UCC staff will complete the checklist to help ensure that the individual is correctly classified as
either an employee or an independent contractor. The department will retain a copy of the completed checklist and forward the
original with the personal service contract to VP of Administrative Services / President for signature.
SECTION A: INDIVIDUAL'S CONTACT INFORMATION
SECTION B: RELATIONSHIP WITH THE COLLEGE
B.1 Is the individual currently working for the college as an employee or has the individual worked for the
college as an employee within the current calendar year?
B.2 Does the individual have a continuing relationship with the college and perform work on reoccurring or
ongoing basis?
Revised 08/20/2012
YES NO
All questions in Section B = NO
All questions in Section C = YES
All questions in Section B = YES
All questions in Section C = NO
Explanation:
Staff Signature Date
Printed Name Department
A W-9 is Attached
IF:
IF:
THEN:
the individual is classified as an employee
C.3 Does the individual possess the appropriate licenses, certifications and insurance?
SECTION F: SIGNATURE OF UCC STAFF COMPLETING CHECKLIST
SECTION D: CLASSIFICATION OUTCOME DISAGREEMENT
This section is to be completed if the department requesting an individual's services disagrees with the checklist's outcome. Send the
completed checklist along with an explanation as to why the department believes the individual should be classified differently than
the classification outcome identified in Section D. The Finance Office will review the explanation with the Human Resources
Department to determine the correct classification. A final determination will be provided to the department within 5 business days.
C.4 Is the individual paid for the end product?
C.5 Are travel expenses included in the price of the contract?
SECTION D: CLASSIFICATION OUTCOME
THEN:
the individual is classified as an independent contractor
SECTION C: EVIDENCE OF CONTRACTOR’S BUSINESS OPERATION
C.1 Does the individual perform work ( or could perform work) at an office, facility or location off campus
that is maintained at the individual's expense?
C.2 Does the individual provide services to other businesses as an independent contractor?
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INSTRUCTIONS FOR COMPLETING CHECKLIST Prior To Engagement, The (Umpqua Community College)

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Completed 27 July 2020

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