ࡱ> ;=:{ bjbjzz 4*     4444,`4x".|||||WWW!!!!!!!$#X&v" WW"  ||2"" | |!!V @W!|Fc+6 !H"0x" x&JZ&W!& W!WL6,WWW""ZWWWx"&WWWWWWWWW : FORT LEWIS COLLEGE EMPLOYEE VS. INDEPENDENT CONTRACTOR DETERMINATION QUESTIONNAIRE The information provided below will assist the College in determining whether the individual performing the services will be classified for federal and state tax purposes as an employee of the College or as an independent contractor. Complete Section I and Section II and ATTACH TO THE PERSONNEL CONTRACT REQUEST (if employee) OR THE CHECK REQUEST (if independent contractor) AS APPROPRIATE. If the check request is used and is for more than $5,000.00 a Personal Service Agreement must be attached. I. ___________________________________________ _____________________________________ (Payees Name Please Print) (FLC ID Number, FEIN, last four digits of social security #) Department_______________________________________ Form Preparer_____________________________________ ________________________________ (Name Please Print) (Phone No.) II. Classification Guidelines A. Lecturer YES NO 1. Is the individual a guest lecturer (e.g., an individual ____ ____ who lectures at only one or two class sessions per semester)? I.C. Emp. B. Current Employment Relationship with College YES NO Does this individual have/had an active job, during the past year, with the College? ____ ____ Go to #2 Go to #C Does the individual have an established business that is substantially different from the duties performed as an employee? Describe work to be performed:__________________________________ ____________________________________________________________ ____ ____ Go to #3 Emp. 3. Does the payee have an FEIN Tax Payer Identification Number with which they will be paid the College for the work detailed in #2 ? ____ ____ I.C. Emp. C. Other YES NO 1. Does the individual routinely provide the same or similar services to the general public as part of a continuing trade or business? If so, attach a client list, business card, brochure or business registration for the vendor. ____ ____ Go to #2 Emp. 2. Does the individual have a written contract for a specified amount of time or to complete a specific result? ____ ____ Go to #3 Emp. Will the College 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 work schedule? ____ ____ Emp. Go to #4 4. Will the department provide this individual with specific instructions regarding performance of the work rather than rely on the individuals expertise and /or provide the materials or tools to complete the work (including a College email address)? ____ ____ Emp. I.C. R I K O ( ? 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