OPERS Independent Contractor Form_fillable PDF Form (1).pdf
PDF 249 KB Posted
- Attached to
- Pickaway Co WA 7 Tree and Brush Removal
- Solicitation number
- SRC0000024426
- Issued by
- Ross County, Ohio
About this file
This document is an OPERS (Ohio Public Employees Retirement System) Independent Contractor/Worker Acknowledgment form. It is to be completed by an individual who begins providing personal services to a public employer on or after January 7, 2013, but is not considered a public employee, such as an independent contractor. The form must be completed within 30 days of beginning service to the public employer. It requires the individual to provide their personal information, including Social Security number, date of birth, and name, as well as the name of the public employer, the employer contact information, the service provided, and the start and end dates of the service.
The document does not provide details on pricing, set asides, incumbents, funding requirements, or other contractual terms. It is solely focused on the acknowledgment that the individual providing services is an independent contractor and not a public employee, and the requirement to complete the form within a specified timeframe.
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Other files
| File | Type | Posted |
|---|---|---|
| OB Contract Example.docx | DOCX document | |
| Standard Affirmation & Disclosure Form_fillable PDF Form (1).pdf | ||
| Ohio buys scope of work Pickaway Co 7.docx | DOCX document | |
| Thomspon Road Tree Removal.jpg | JPG image | |
| DAS Terms And Conditions.pdf | ||
| OPERS Independent Contractor Form_fillable PDF Form (1).pdf | ||
| DAS Terms And Conditions.pdf | ||
| Thomspon Road Tree Removal.jpg | JPG image | |
| Standard Affirmation & Disclosure Form_fillable PDF Form (1).pdf | ||
| OB Contract Example.docx | DOCX document | |
| Ohio buys scope of work Pickaway Co 7.docx | DOCX document |
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Text version
OPERS
INDEPENDENT CONTRACTOR/WORKER
ACKNOWLEDGMENT
Ohio Public Employees Retirement System 277 East Town Street, Columbus, Ohio 43215-4642
Employer Services: 1-888-400-0965 www.opers.org
This form is to be completed if you are an individual who begins providing personal services to a public employer on or after
Jan. 7, 2013 but are not considered by the public employer to be a public employee (e.g, you are an independent contractor) and will not have contributions made to OPERS. This form must be completed not later than 30 days after you begin providing personal services to the public employer.
STEP 1: Personal Information
Social Security Number
Date of Birth
Month Day
I First Name
Year
I
Name of Current Employer
Ml Last Name
0 I am an OPERS or other retirement system benefit recipient
STEP 2: Public Employer Information
Name of Public Employer for Which You Are Providing Personal Services
Employer Contact
First Name Ml Last Name
Employer Code Employer Contact Phone Number
Service Provided to Public Employer
Start Date of Service End Date of Service
Month Day Year Month Day Year
I I I j
PEDACKN (Revised 6/2017) Page 1 (continued on back)
File details come from the government source that posted it. Updated .