UNIVERSITY OF MAINE

INDEPENDENT CONTRACTOR/CONSULTANT AUTHORIZATION

Name of Independent Contractor (if known)___________________________________

Social Security # /Federal Employer Id (if applicable)____________________________

Project Amount $ _____________________ Expected Start Date__________________

Department __________________________ Expected Termination Date ___________

Responsible University Project Manager ______________________________________

Telephone: _________________ FAX: _______________ E-MAIL: _______________

Specifications of Work: Describe the services to be provided by the above independent contractor/consultant.

CRITERIA:

The following criteria are general guidelines used by the IRS to determine whether or not an individual is functioning as an independent contractor/consultant. The fact that an individual is not now a University employee or that the work is short-term does not qualify the individual as an independent contractor/consultant. An individual (who is not doing business as a corporation or a legal partnership) who has been assigned a federal employer ID may not necessarily be considered as an independent contractor/consultant.

Answer the following questions by circling YES or NO

 1.  Will a University employee direct the person providing this

     service as to when, where, and how to work?             YES    NO

 2.  Will the University control the sequence of the work?   YES     NO

 3.  Will a University employee have responsibility for hiring,

     supervising or paying for any assistants to the project?        YES     NO

 4.  Will work hours be set by the University?                       YES     NO

 5.  Is work to be performed on University property?         YES     NO

 6.  Will tools and/or equipment be supplied by the University?      YES     NO

 7.  Are payments to be made regularly (monthly, weekly)?    YES     NO

 8.  Is compensation to be provided for travel or business

     expenses?                                                  YES  NO

 9.  Will the individual provide materials and supplies for

     the job?                                                   YES  NO

10.  Will the individual have an investment or share in the

     profit/loss of the job?                                  YES    NO

11.  Will the individual do same work for other companies

     outside the University?                                 YES     NO

12.  Does the individual have employees of his/her own?              YES     NO

13.  Does the University have the right to discharge the

     worker?                                                   YES   NO

Additional comments/explanation:___________________________________________ _______________________________________________________________________ _______________________________________________________________________

Approved:

        ______________________________        ____________________

        Office of Human Resources                     Date

INSTRUCTIONS:

· The Purchasing Department will need the following, in addition to this approved form, to complete this process and facilitate payment.

· The Independent Personal Service Contract (available from Central Supply), completed by the department and signed by the contractor/consultant.

· A Requisition for Purchase Form or electronic requisition completed and authorized by the department.

OHR 4/95

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Last modified August 15, 2002