INSTRUCTIONS FOR COMPLETING CHECKLIST
First name Last Name
Federal Id#: Telephone
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
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