Jordan School District
INDEPENDENT CONTRACTOR DECLARATION
I, , doing business as
, declare that I
am acting as an “independent contractor” and not as an “employee” in performing services for
Jordan School District. I will be responsible for the payment of all federal and state income
taxes, FICA, or Social Security taxes, and all other applicable employment taxes. I understand
that no taxes will be withheld from payments made to me.
Date Social Security or Signature
TIN Number
Rev. Rul. 87-41 sets forth the 20 common law factors to determine whether workers are
employees or independent contractors. Workers are generally employees if they:
1. Must comply with employer’s instruction about work.
2. Receive training from, or at the direction of, the employer.
3. Provide services that are integrated into the business.
4. Provide services that must be rendered personally.
5. Hire, supervise, and pay assistants for the employer.
6. Have a continuing working relationsip with the employer.
7. Must follow set hours of work.
8. Work full-time for an employer.
9. Do their work on the employer’s premises.
10. Must do their work in a sequence set by the employer.
11. Must submit regular reports to the employer.
12. Receive payments of regular amounts at set intervals.
13. Receive payments for business and/or traveling expenses.
14. Rely on employer to furnish tools and materials.
15. Lack a major investment in facilities used to perform the services.
16. Cannot make a profit or suffer a loss from the services.
17. Work for one employer at a time.
18. Do not offer their services to the general public.
19. Can be fired by the employer.
20. May quit work at any time without incurring liability.
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