Independent Contractor Recruitment Form

Independent Contractor Recruitment Form

Personal Information
Referral Manager's Name
For Questions send a text to:
Mon-Sun 10:00 AM -6:00 PM
Full Name

First NameMiddle NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Social Security Number
Birth Date

MonthDayYear
Your SSN is essential for background checks, identity verification, and legal compliance in employment, including tax and work eligibility. We enforce robust security measures to protect your information, limiting access to trained personnel and safeguarding it from unauthorized breaches. Providing your SSN is mandatory for the application process, and not doing so may halt further processing of your application.
Safelink Only Authrorization & Disclosure Forms

Safelink Only Authorization Form

Safelink Only Disclosure Form
RAI ID
RAD ID Registration # (9-12 Characters)
Our commitment to your privacy ensures the secure handling of your information, with RAD ID minimizing personal data use. Providing your RAD ID implies consent for its necessary use in application processing, where not providing it could result in delays or processing issues.

To acquire a RAD ID click on the link below

https://lifelinerad.org/rad/#
RAD ID Email Screenshot

Browse Files
Take a screenshot of the email sent to you by USAC Cancelof
Photo ID

Browse Files
Please Submit a Government Issued ID Cancelof
Headshot

Browse Files
Please remove any headwear, glasses, and masks on a solid background. Cancelof
If you have any questions or concerns
Signature
Should be Empty: