SECTION 2: If answers to any of the above questions are answered “NO”, the individual is not an independent
contractor and must be hired as an employee.
INDEPENDENT CONTRACTOR CHECKLIST
Name of proposed independent contractor:
SECTION 1: The individual to perform the services:
• Provides similar services to other clients and/or businesses.
• Engages in entrepreneurial activities in an established trade, occupation or business and
is at risk for profit or loss.
• Will receive little or no training, supervision, or instruction from MSU Billings, other
than conveying the scope of service desired.
• Is not a current employee of MSU Billings and has not been an employee of MSU
Billings within the last six months.
• Will be responsible for determining means and methods to use to perform services.
• Will provide his/her own supplies, equipment, forms, etc., necessary to perform
services, and the cost of these is included in rate or total fee.
• Will maintain worker's compensation coverage and will present proof of coverage or
will present proof of exemption.
• Will set his/her own priorities on time, amount of effort, and hours of work, to
accomplish services within stated time frame.
• The services to be provided are not similar to those currently being provided by any
MSU Billings employee(s).
• Will be paid on the basis of a completed project or in a manner consistent with others in
the same trade, occupation, profession or business.
YES NO
Authorized Signature
Date:
I certify that to the best of my knowledge the above is correct.
NOTE: This form is to be completed and signed by the appropriate Department Head at MSU Billings.
Department
Phone #
click to sign
signature
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