OPERS Independent Contractor Form_fillable PDF Form (18).pdf

This document is an Independent Contractor/Worker Acknowledgment form from the Ohio Public Employees Retirement System (OPERS), located in Columbus, Ohio. The form is designed for individuals who begin providing personal services to a public employer on or after January 7, 2013, but are not considered public employees, such as independent contractors. The form must be completed within 30 days of beginning service and requires detailed information about the individual's personal details, current employer, and the public employer for whom services are being provided.

The form outlines specific criteria for independent contractor classification, including being party to a bilateral agreement, being paid a fee or retainer, not being eligible for employee benefits, not appearing on a public employer's payroll, and providing personal supplies and equipment. The document emphasizes that as an independent contractor, no retirement system contributions will be made, and the individual may face limitations on future medical reimbursements or allowances. The form requires the individual to acknowledge their understanding of their classification and potential implications, with a signature affirming awareness of their status as a non-public employee.