Formulario

Contractor Information 2024

Florida
Position*

DishwasherHousekeeperServerCashierCookFood RunnerPrep cookWarehouseBartenderOther
Personal information
Full Name*

First NameLast Name
Birthdate*
MM-DD-AAAA
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City you would like to work*
Social Security Number (SSN)
Number*
NOTE: If you are not a U.S. citizen, you must provide photo of the following:
- Employment authorization card or Permanent resident card (Instead of a state ID or driver's license)
- Work authorized Social Security Card (SSN)
Upload a photo of a valid U.S. Identification card*

Cancelof
Upload a photo of Social Security Card (SSN)*

Cancelof
Are you a citizen of the United States?*

YesNo
Are you authorized to work in the United States?*

YesNo
You have passport?*

YesNo
what languages do you speak?*

EnglishSpanishOther
Have you previously worked for Nexus?*

YesNo
Have you ever been convicted of a crime?*

YesNo
Availability
Weekly availability*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Experience
Previous Position/Role: Escribir una etiqueta*
Company Name: Escribir una etiqueta*
Start Date: Date*
End Date: Date*
Previous Supervisor Name: Full Name*
Phone Number: Full Number*
Certifications
Are you certified as a food handler?*

YesNo
Do you have any other relevant certification/licenses?*

YesNo
References (if applicable)
Full Name
Relations
CompanyPhone number
How did you know about us?*

Social networksSearch engines Google, Bing, Yahoo.NewspaperRecommendationOther
Request for Taxpayer Identification Number and Certification.

Form W-9
Check the appropriate box for the federal tax classification of the person whose name is entered on line 1.
Check only ONE of the following seven boxes.*

Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estateLimited liability company. Enter tax classification (C=C Corporation, S=S Comporation, P=Partnetship)Other
If you selected "Limited liability company": Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):
Exempt payee code (if applicable)
Exemption from FATCA reporting code (if applicable)
Independent Contractor Agreement
I certify that my answers are true and complete to the best of my knowledge and belief. I understand that false or misleading information on my application or interview may result in my release from the company. I acknowledge and understand that because I am an independent contractor, Nexus Staffing Group, its subsidiaries and affiliated companies do not maintain workers' compensation, general liability or automobile liability insurance for contractors or contractor employee benefits. A contractor package is available upon request. By signing, I agree to all of the above terms and conditions.
Signature*

Powered by Jotform SignLimpiar
Date*

MonthDayYear
Date
Should be Empty:

Contractor Information 2024

Personal information

Social Security Number (SSN)

Availability

Experience

Certifications

References (if applicable)