Signature / Certification
I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for immediate denial of my appointment or removal from consideration or, if I have entered into a contract with this company, for immediate termination of that contract. I authorize ACFS to make any necessary inquiries and investigations into my education, references, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to ACFS by any of the schools, services, or employers listed on this application.
I also hereby release from liability ACFS and its representatives for seeking, gathering, and using such information to make decisions concerning my status as an independent contractor for ACFS and all other persons or organizations for providing such information.
THIS IS NOT AN APPLICATION FOR EMPLOYMENT. I understand and agree that if this application is accepted, my status will be that of an independent contractor and as such, I will be solely responsible for all tax liabilities pertaining to monies received in the course of services I perform.
If I am retained by ACFS as an independent contractor I will:
• not be entitled to workers compensation benefits.
• not be entitled to unemployment insurance benefits unless unemployment coverage is provided by me or some other entity.
• be obligated to pay federal and state income tax on any moneys paid pursuant to the contract relationship.
• be required to provide professional and liability insurance.
I represent and warrant that I have read and fully understand the foregoing, and that I seek to become an independent contractor under these conditions.
