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Instructions Application
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NOTE: Service providers may be required to complete the independent contractor determination form.

Individuals, unincorporated businesses (i.e. dba), and certain single member LLC’s (SMLLC) might be considered employees rather than independent contractors. The IRS views SMLLC’s as “disregarded entities”. As such, SMLLC’s are not separate from their owners unless an election is made to be treated as a corporation. These providers are required to be approved as independent contractors through the determination form.

Non individuals, including corporations, partnerships, LLPs, multi-member LLC’s, and LLCs electing corporation status are automatically independent contractors and will not be considered employees. These entities are not required to complete the determination form.

Per the provider, the provider is:


The HR Independent Contractor Determination Form is NOT required. You do not need to continue this process and will not require this approval in order for accounts payable to process payment. If you are engaging a foreign entity, please e-mail intltax@kent.edu prior to finalizing the contract as there may be tax withholdings and/or special tax reporting requirements.

Requesting Department Information
The individual completing the form must fill in all required information as indicated by the asterisk *.
Campus*: Requesting Department*:
Name of Person Completing Form*: Email of Person Completing Form*:
Phone Number of Person Completing Form*: Fax Number of Person Completing Form:
Hiring Authority
If the person completing this form is the hiring authority click here to duplicate the above information, else please complete the following with the hiring authority's information.
Name of Hiring Authority*: Hiring Authority's Email Address*:
Hiring Authority's Phone Number*: Hiring Authority's Fax Number:
Individual to Perform Services Information
Name of Individual to Perform Service*: United States Social Security Number of Individual to Perform Services*:
Individual's Date of Birth*: Telephone Number of Individual to Perform Services*:
Individual's Resident Status*:
Individual's Email:
Full Address of Individual to Perform Service*:
Is this individual a current KSU employee/student employee*:
Has this individual been a KSU employee/student employee within the past 12 months?*:
If yes, what was their position and how did the employement relationship end?* (e.g., did the employee voluntarily quit or was the employee terminated):
Is this individual a relative or business associate of a KSU employee?*:
If yes, list relative or business associate’s name*
Has this individual been an Independent Contractor at KSU in your department within the past 6 months?*:
If Yes, what service did they perform or project did they complete?*:
Anticipated Start Date*: Anticipated End Date*:

If work has already started, provide explanation for late submission of this request:
Provide a brief description of the work to be performed*:
Provide a summary of the qualifications of the individual*:
What will the individual do with the finished product?* (i.e., do they return it to the university, sell it or keep it?):
Is the individual's work vital to the university's core business?*:
If Yes, provide explanation*:
Is training by the university necessary for the individual to perform tasks in a specific way?*:
If Yes, provide explanation*:
Will it be necessary for this individual to receive on-going supervision?*:
If Yes, provide explanation*:
Who is the individual required to contact if any problems or complaints arise and who is responsible for the resolution?*
Will the individual receive extensive instruction on how the work is to be performed?*:
If Yes, provide explanation*:
Will the department schedule how, when or where to do the work?*:
If Yes, provide explanation*:
Will the work be performed in a KSU department or facility?*:
Where will services be performed? Indicate city, state, and if not within the United States – country*:
Will the individual be required to submit regular reports, either written or oral?*:
If Yes, provide explanation*:
Will the individual be provided with any university tools, materials or equipment?*:
If Yes, provide explanation*:
What is the expected amount of payment?*: $
How will the individual be paid?*:
If other, provide a detailed explanation*:
How will the individual be reimbursed for travel and/or business expenses?*:
If other, provide a detailed explanation.*:
Can the individual terminate the relationship without liability?*:
If Yes, provide explanation*:
Is this request part of a grant-funded project?*:
If Yes, provide explanation*:
Is there a draft or an unsigned written agreement available?*
Upload the draft or unsigned written agreement at the end of this form. The independent contractor should be able to provide the department with this draft or unsigned written agreement. If not, then a draft written agreement may be downloaded from the HR Forms Library by clicking on the Miscellaneous link, Complete the required information and submit an unsigned copy with this form.
Explain why the department believes the individual is an independent contractor*:
Please read and acknowledge I certify that I have made every effort to obtain the information necessary to complete this form and all information and statements made are true and accurate to the best of my knowledge. I understand that any form not fully completed may be immediately denied or returned to me for further information. I understand that any attempt to provide false or misleading information or statements is not only a violation of this form but may be a violation of the rules of my employment as well, the consequences of which may include disqualification from further access to this form up to and including appropriate disciplinary action.