1099 Contractors - Outstaffing, Inc.

Fields marked with * are required

Business Name *

Your Name (Person Submitting Form) *

Contract Employee Full Name *

Contract Employee Email Address *

Address 1 *

Address 2

City *

State *

Postal Zip Code *

Contracted Employee Supervisor *

Start Date *

mm-dd-yyyy

Job Title *

Do you want a background check run on your new contracted employee? *

(For details, refer to Background Checks in Employer Payroll Services. A release form signed by the new hire is required.)

Is your new contracted employee eligible for the Call A Doctor Program? *

Authorization *

I have examined the information and confirm that I have the authority to submit this form to Outstaffing.