OPERS Independent Contractor Form_fillable PDF Form.pdf
PDF 249 KB Posted
- Attached to
- Beaver Wildlife Area Sunflower Field
- Solicitation number
- SRC0000017372
- Issued by
- Marion County, Ohio
About this file
The document is an Ohio Public Employees Retirement System (OPERS) Independent Contractor/Worker Acknowledgment form. This form is to be completed by individuals who begin providing personal services to a public employer in Ohio 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 to provide services. It requires the individual to provide personal information, the name of the public employer, the service being provided, and the start and end dates of the service.
The related state and local contract opportunity is for a bid to plant a 5-acre sunflower field at the Beaver Wildlife Area in Marion County, Ohio. No other details about the contract, such as pricing, timelines, or application requirements, are provided in the given information.
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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 .