Independent Contractor Questionnaire

Contracting and Purchasing Services Intranet

INDEPENDENT CONTRACTOR QUESTIONNAIRE

Fields with (*) are mandatory

This questionnaire must be completed and submitted to Human Resources/Employment Services before utilizing the services of an individual contractor. This contractor form must be completed even in those cases where payment is to be made to the individual's business rather than to the individual.

If it is determined that the individual qualifies as an independent contractor, then you will receive an e-mail with a link to an Independent Contractor Agreement which must be completed and signed. Submit the contract to Payable Accounting when processing the payment. If it is determined that the individual should be processed as an employee rather than an independent contractor, then the necessary employment forms should be processed through Human Resources/Employment Services.

Please provide the following information concerning the individual whom you would like to hire.

Name of Individual:*

Name of Business:*

Address:*

City:*

State:*

Zip:*

Type of entity:

Answer the following questions to determine Independent Contractor/Employee status:

Describe the services that will be performed including date(s) and location(s) where services will be performed.*

How much control does the University have over the method, process and details of how and when this work is performed?*

Yes

1. Is this individual a student at CMU? If Yes, process this individual through Student Employment.*

2. Is this individual currently employed at CMU? If Yes, process through Human Resources/Employment Services or Faculty Personnel Services.*

3. Is this individual legally eligible to work in the United States for CMU? If No, please do not proceed through the rest of the questionnaire.*

4. Is the contractor at least 18 years of age? If No, contact Human Resources.*

5. Is this individual immediately related to any employee in the University? If yes, specify person and relationship:*
Name:*
Relationship:*
Note: For conflict of interest information, please visit Contracting & Purchasing Services' Website.

6. Will the University provide any training for this individual?*

7. May this individual designate another to perform services?*

8. Will this individual supervise employees of the University?*

9. Have you contracted with this individual before for similar services? If yes, indicate period(s) of previous contract(s).*

10. How long will this individual perform their services for you?*

11. On average, how many hours will the individual work per week?*

12. Will this individual be required to provide reports (oral or written) to University personnel?*

13. How will this individual be paid?* Is payment > $4,999.99? Yes No Enter (est.) dollar amt :

14. Will the University reimburse this individual for any expenses while performing these services (e.g. travel, telephone, supplies)? If Yes, describe the reimbursements.*

15. Will this individual be able or need to perform some of the services at a location he/she provides for themselves?*

16. Will the University provide an office or workspace for the individual?*

17. Will the University provide support services (e.g copying, clerical)?*

18. Will the University furnish the individual with tools, materials or supplies?*

19. Does this individual have a business location outside their home? If yes, what is the name and address of the business?*

20. Has this individual provided the same or similar services to others outside of CMU within the last six months?*

21. Will the University set the number of hours and/or days of the week that the individual is required to work as opposed to allowing the individual to set their own schedule?*

22. Is there any other information which would support the treatment of this individual as an independent contractor? If so, please describe:*

The CMU employee completing the questionnaire should provide the following information:

Department:*

Check if using a 6 digit WBS element:

Cost Center or WBS: (use digits only)*

Date(mm/dd/yyyy):*

Print or Type Name:*

Telephone Number:*

Campus Address:*

Requestor's Email:*

The questionnaire will automatically transmit to Human Resources/Employment Services or ORSP (if WBS element is checked or a grant cost center is used), when "submit" is clicked on.

Please only click the submit button once. Do not double click.