1099 Contractor

NEW HIRE INFORMATION

1099 Contractor Form

Name(Required)
Address(Required)
MM slash DD slash YYYY

WORKSITE/ORDER INFORMATION

*If through VMS, please include the name of both the VMS and worksite Client. Ex: AnnLeo-ABC Assisted Living*

PAY RATES/BILL RATES

Supervisor Name(Required)
Alt. Supervisor Name
Background/Drug Screen Ordering Options
Additional charges may apply depending on your county/state of residence
Max. file size: 100 MB.
Submitted By *(Required)
MM slash DD slash YYYY

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