REQUESTOR	DATE
LOCATION	Name of Individual you would like to hire

You have submitted a Purchase Requisition for temporary service approval.  Additional information is needed before approval can be made.  The following questions are designed to help determine whether an individual is an independent contractor or an employee.  Please answer “yes” or “no” to the following questions.  In No Case should the individual be allowed to begin work before authorization has been received.

Primary considerations

1.	Is the work performed under a written contract or agreement?	Yes	No
2.	Is the individual solely responsible for the outcome of a specific project meeting your overall specifications, but free to decide how the specifications are met?	Yes	No
3.	Is the individual able to set his or her own hours and schedule?	Yes	No
4.	Does the individual provide his or her own tools, materials, and supplies?	Yes	No
5.	Has the individual made a significant investment in the means necessary to provide a service?	Yes	No
6.	Is the work be performed at an offsite location (not designated by you), or is the work being performed at your site until the completion of the project?	onsite	offsite
7.	Can the individual authorize another person (non-district employee) to perform the work?	Yes	No
8.	Does the individual have the ability to hire, pay, and supervise assistants, answerable only to the individual and not to you?	Yes	No
9.	Can the individual work for other employers simultaneously while performing work for you?	Yes	No
10.	Are the only grounds for dismissal the failure to meet the obligations of the contract or agreement?	Yes	No
Secondary considerations
11.	Is the individual compensated for the completion of a specific project or job rather than by the hour?	Yes	No
12.	Is the individual responsible for paying his or her business expenses?	Yes	No
13.	Is the individual responsible for his or her own training and continued education?	Yes	No
14.	Is the individual responsible for personal behavior if charged with negligence?	Yes	No
15.	Is the individual precluded from quitting until the completion of the job?	Yes	No

After completing this form, click the SUBMIT button and it will be sent to Patty Norwig in the Human Resource Department for processing.  You will be notified by email once a determination has been made.  If a determination is made that the individual is an employee, the Staffing Specialist for your location will contact the individual to come in and fill out the necessary paperwork.  If it has been determined that the individual is an independent contractor, your request will be approved and forwarded to the Purchasing Department.

Check box

By submitting this form for approval, I attest that the information provided above is both true and accurate to the best of my knowledge.