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1 Independant Contractor Information

Cristian Ruiz Lopez submitted an independent contractor application providing personal and employment details. The application requests information including name, address, phone number, driver's license, social security number, availability, hourly rate, work history from previous employers, references, and authorization to conduct a background check. Ruiz Lopez aims to be eligible for painting jobs by submitting the required information and documents.

Uploaded by

Josue Lopez
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© © All Rights Reserved
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54 views6 pages

1 Independant Contractor Information

Cristian Ruiz Lopez submitted an independent contractor application providing personal and employment details. The application requests information including name, address, phone number, driver's license, social security number, availability, hourly rate, work history from previous employers, references, and authorization to conduct a background check. Ruiz Lopez aims to be eligible for painting jobs by submitting the required information and documents.

Uploaded by

Josue Lopez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INDEPENDENT CONTRACTOR INFORMATION

THE FOLLOWING INFORMATION MUST BE PROVIDED TO BE ELIGIBLE FOR THIS JOB.

LEGIBLY ENTER THE FOLLOWING INFORMATION.

1. NAME: Cristian Eduardo Ruiz Lopez DATE: 04-18-2022

CO. NAME (IF YOU ARE A BUSINESS): FIRST TO PAINTING LLC

LIABILITY INSURANCE CO.: NXTLVVCQQF-00-GL PHONE #

2. CELL PHONE #: 5713364120 SERVICE WITH:TMOBILE

3. HOUSE TELEPHONE #: FAX #:

4. YOUR ADDRESS:5713 HARWICH CT. #232 VA 22311

HOW LONG IN THIS DIRECTION? 5 YEARS,MONTHS 0

ARE YOU PERSONALLY THE OWNER OF THIS PROPERTY (NAME IN DEED)? (Y/N) N

IF YOU RENT, IS YOUR NAME LEASED? (Y/N) AND , IF NOT, WHAT IS YOUR LIVING

SITUATION? DO YOU PAY RENT? HOW OFTEN AND TO WHOM I PAY RENT

5. DRIVER'S LICENSE? (AND/OR) AND , IN WHAT STATE? VIRGINIA

DOES THE ADDRESS MATCH WHERE YOU LIVE? (Y/N) And

(THIS INFORMATION IS NECESSARY TO OBTAIN THEFT BOND INSURANCE


AND DETERMINE ELIGIBILITY FOR KEYS AND ACCESS TO VARIOUS JOB
SITES.)
6. DO YOU HAVE A SOCIAL SECURITY CARD OR EIN DOCUMENT? (AND/OR) AND BRING
YOUR CARD/EIN ON THE 1ST DAY OF WORK. ( NOTHING ELSE WILL BE ACCEPTED )

DID YOU FILE TAXES FOR 2020?( Y/N) AND, BRING A COPY ON THE FIRST DAY OF
WORK.

7. ANY CRIMINAL RECORD?( Y/N) N IF YES; ATTACH POLICE PRINTING.

8. ANY MEDICAL CONDITIONS? (Y/N) N IF YES; DISCLOSE THE CONDITION OR INJURY

REFERENCE NAME:

TELEPHONE # : TOTAL AMOUNT $

DESCRIPTION OF WORK (ATTACH INVOICE):


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INDEPENDENT CONTRACTOR INFORMATION
(ATTACH PAGES IF NECESSARY)

SMOKE? (Y/N) N HOW MANY 15 MIN. BREAKS / DAY?

9. WHAT FAX NUMBER CAN I USE TO SEND


INFORMATION BY EMAIL?
[email protected]

10. WHAT DAYS ARE YOU AVAILABLE TO WORK?


EXAMPLE: MON. – FRI. MONDAY TO SUNDAY

11. WHAT HOURS ARE YOU AVAILABLE TO WORK? EXAMPLE: 7:00 - 7:00 MON. – FRI.
FROM 7:00 AM TO 7:00 PM

12. $/HR, WHAT IS YOUR HOURLY RATE. EXAMPLE: $10.00/HR. $50.00

13. WORK HISTORY: EMPLOYER NAME, DATES OF EMPLOYMENT, CITY, STATE, PHONE
NUMBER, WHERE YOU: EMPLOYEE W-2, 1099 SUB. CONT., OR SELF-EMPLOYED?

EMPLOYER NAME: IRMA ALVARENGA

ADDRESS:___________________________________________________

CITY: VIRGINIA STATE: ZIP:

OWNER'S OFFICE OR TELEPHONE #

START DATE:2019 END DATE:

W-2 (Y/N) , 1099 SUB. CONT. (Y/N) , SELF-EMPLOYED (Y/N) _

IF THE SELF-EMPLOYED BILLED THEIR CUSTOMERS? (Y/N) And

WAS THE INCOME FROM THIS WORK REPORTED TO THE IRS? (Y/N) And

14. CONTINUOUS WORK HISTORY (COPY THIS PAGE IF YOU NEED ADDITIONAL FORMS ):
EMPLOYER NAME:

ADDRESS:

REFERENCE NAME:

TELEPHONE # : TOTAL AMOUNT $

DESCRIPTION OF WORK (ATTACH INVOICE):


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INDEPENDENT CONTRACTOR INFORMATION
CITY: STATE: ZIP:

OWNER'S OFFICE OR TELEPHONE #

START DATE:END DATE :

W-2 (Y/N) , 1099 SUB. CONT. (Y/N) , SELF-EMPLOYED (Y/N) _

IF THE SELF-EMPLOYED BILLED THEIR CUSTOMERS? (Y/N)

WAS THE INCOME FROM THIS WORK REPORTED TO THE IRS? (Y/N)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

EMPLOYER NAME:

ADDRESS:

CITY: STATE: ZIP:

OWNER'S OFFICE OR TELEPHONE #

START DATE:END DATE :

W-2 (Y/N), 1099 SUB. CONT. (Y/N) , SELF-EMPLOYED (Y/N) _

IF THE SELF-EMPLOYED BILLED THEIR CUSTOMERS? (Y/N)

WAS THE INCOME FROM THIS WORK REPORTED TO THE IRS? (Y/N)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

EMPLOYER NAME:

ADDRESS:

CITY: STATE: ZIP:

OFFICE OR OWNER'S PHONE #

START DATE:END DATE :

W-2 (Y/N) , 1099 SUB. CONT. (Y/N) , SELF-EMPLOYED (Y/N) _

IF THE SELF-EMPLOYED BILLED THEIR CUSTOMERS? (Y/N)

REFERENCE NAME:

TELEPHONE # : TOTAL AMOUNT $

DESCRIPTION OF WORK (ATTACH INVOICE):


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INDEPENDENT CONTRACTOR INFORMATION
WAS THE INCOME FROM THIS WORK REPORTED TO THE IRS? (Y/N)

15. HIGH SCHOOL DIPLOMA? (Y/N), YEAR OF GRADUATION:

VOCATIONAL TRAINING? (Y/N) INCLUDE ANY

COMMERCIAL ACCESSORY DOCUMENTS? (Y/N) INCLUDE ANY

DOCUMENT

UNIVERSITY COURSES? (Y/N) (INCLUDE TRANSCRIPTS IF YOU HAVE THEM)

16. REMODELING REFERENCES: NAME, ADDRESS, PHONE NUMBER, DESCRIPTION OF


THE JOB YOU PERFORMED (DO NOT INCLUDE THE JOB CONTRACTED TO OTHERS).

DID YOU SUBMIT AN INVOICE? (Y/N)¿ N DO YOU HAVE A COPY OF THE INVOICE?
(AND/ N) IF YES, ATTACH A COPY OF THE SIGNED INVOICE YOU USED TO INVOICE
THIS CUSTOMER.

REFERENCE NAME :

PHONE # : TOTAL AMOUNT $

JOB DESCRIPTION (ATTACH INVOICE):

DID YOU SUBMIT AN INVOICE? (AND/OR)DO YOU


HAVE A COPY OF THE INVOICE? (Y/N)
IF YES, ATTACH A COPY OF THE SIGNED INVOICE YOU USED TO INVOICE THIS
CUSTOMER.
17. CONTINUATION OF THE REMODELING REFERENCES :

REFERENCE NAME:

TELEPHONE # : TOTAL AMOUNT $

DESCRIPTION OF WORK (ATTACH INVOICE):


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INDEPENDENT CONTRACTOR INFORMATION

REFERENCE NAME :

PHONE # : TOTAL AMOUNT $

JOB DESCRIPTION (ATTACH INVOICE):

DID YOU SUBMIT AN INVOICE? (Y/N) , DO YOU HAVE A COPY OF THE


INVOICE? (Y/N) IF YES, ATTACH A COPY OF THE SIGNED
INVOICE YOU USED TO INVOICE THIS CUSTOMER.
------------------------------------------------------------------------------------------------------------------------

REFERENCE NAME:

TELEPHONE # : TOTAL AMOUNT $

DESCRIPTION OF WORK (ATTACH INVOICE):


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INDEPENDENT CONTRACTOR INFORMATION

DID YOU SUBMIT AN INVOICE? (Y/N) , DO YOU HAVE A COPY OF THE


INVOICE? (Y/N) IF YES, ATTACH A COPY OF THE SIGNED
INVOICE YOU USED TO INVOICE THIS CUSTOMER.

18. INDEPENDENT CONTRACTOR DAILY WORK AGREEMENT AND BACKGROUND CHECK


AUTHORIZATION. READ, BUT DO NOT FILL IN THE INFORMATION OR FAX IT.
19. THE PRINTED NAME AND SIGNATURE AT THE BOTTOM OF THIS PAGE GIVE
DARNELL DOES IT ALL LLC PERMISSION TO VERIFY EMPLOYMENT, REFERENCES,
AND OTHER INFORMATION PROVIDED ON THIS APPLICATION.

CRISTIAN RUIZ 04/18/202


PRINT NAME SIGN NAME DATE

THANK YOU FOR COMPLETING THIS APPLICATION


PLEASE CALL ME AFTER FAXING IT SO I CAN GET YOU WORKING AS SOON AS
POSSIBLE

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