Worker Classification Determination Request Form
Use this form to provide all relevant details needed to determine whether a worker should be classified as an employee or independent contractor. Please complete all applicable sections.
Requester Name
*
First Name
Last Name
Requester Email
*
example@example.com
Business or Department Name
*
Worker Name
*
First Name
Last Name
Describe the work to be performed
*
Relationship Details
*
Compensation Arrangement
*
Please Select
Hourly wage
Salary
Project-based
Commission
Other
Who determines how and when the work is done?
*
Please Select
Business/Requester
Worker
Both jointly
Work Location and Schedule
*
Who provides the tools, equipment, or materials?
*
Please Select
Business/Requester
Worker
Both
Submit
Should be Empty: