Example: bankruptcy
IMPORTANT: PLEASE READ BEFORE COMPLETING APPLICATION

IMPORTANT: PLEASE READ BEFORE COMPLETING APPLICATION

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NOTICE TO APPLICANT: Predetermination of independent contractor status is based upon the information provided in this application. Participation in the submission of a fraudulent or intentionally misleading form can result in fines of up to $1,000 for an individual and up to $10,000 for a corporation, partnership or other legal entity.

  Independent, Status, Contractor, Predetermination, Predetermination of independent contractor status

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