Independent Contractor Request Form

AB 5 is a bill the California Governor signed into law in September 2019 addressing employment status when a hiring entity claims that the person it hired is an independent contractor and must determine if workers in California are employees or independent contractors for purposes of the Labor Code, the Unemployment Insurance Code, and the Industrial Welfare Commission (IWC) wage orders. For more information, please visit: https://www.dir.ca.gov/dlse/faq_independentcontractor.htm


Instructions: Please complete the below form and attach the necessary documentation. It is important to receive Human Resources approval prior to placing on the Board agenda for Board approval.

General Information


Work Performed by Independent Contractor

Please check all that apply.

Please select all that apply.


How Will the Independent Contractor be Paid?

Please explain the other method of payment.


Requesting Department Contact Information

Please complete the below for best contact information in the case there are any questions or concern.


Documents to Review

1. Quote/Proposal

2. Signed W-9

3. Other supporting documentation

Drag and drop files here or