Independent Contractor Application

Please complete the form accurately with all requested information.
If you have difficulty completing this application, please email for assistance. 
Contact Information
Application Materials

- I have private/reliable transportation
- I understand that this position is classified as an independent contractor
- I will provide tax information (as requested by a W9 at the time of hire)
- I hold, or will apply for PA State Clearances (Act 33, Act 34, Act 151) as required by all entities which work or volunteer with children.
- I have never been convicted of a criminal offense.
- I am not currently under charges for a criminal offense.
- I have never forfeited bond or collateral in connection with a criminal offense.
- I have not been fired from any job or contract within the last 10 years.
- I have not quit or terminated any job or contract within the last 10 years after being notified I would be fired.
- I have not been professionally disciplined in ANY state in the last ten years.
- I am not subject to any visa or immigration status that would prevent me from taking on work as an independent contractor.

**If you cannot agree to any of the above statements, please indicate why in your statement of intent **