Independent Contractor Application

APPLICANT INFORMATION

Respondent

First name *

Last name *

Company

Email *

Mobile *

Address *

City *

Country *

State/Province *

Zip/Postal code *

CLASS NAME & DESCRIPTION

Name of Class or Offering *

Please describe the class and/or what the participant can expect as a result in taking your class. *

FEES & ENROLLMENT MINIMUMS

Class Fee *

Fee amounts are what the participant pays per class/program. Instructor will be paid out on agree upon split. Split percentages are 60/40 for classes held at District facilities and 70/30 not held at District facilities.

Minimum enrollment needed to run the class. *

CLASS DATES & TIMES

Activity Guide Season(s) you wish to offer the class *

Winter/Spring (Jan-April) Summer (May-Aug) Fall/Winter (Sept-Dec)

Days of the Week *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Number of classes and duration per offering. *

e.g. M/W for 3 weeks

Preferred class times. *

Please describe your facility space needs. *

REFERENCES

Are you currently instructing this class elsewhere? *

Yes No

If yes, please include where.

References *

Please list 3 references that are familiar with your work. Include name and email/phone number.

CONVICTIONS

Have you ever been convicted by a court of a felony? *

Conviction will not necessarily disqualify an applicant from agreement. All interested parties will be required to be fingerprinted prior to start of agreement.

Yes No

If yes, please explain what conviction, when, where and disposition of the case:

ACCEPTANCE & DISCLAIMER

I have reviewed the Independent Contractor Handbook.

I have read and accept *

Disclaimer*

Independent contractors are contracted with the Fair Oaks Recreation and Park District to provide instruction for recreational activities and are not employees of the District. Independent contractors shall be dismissed at any time if the District finds their instruction to be inadequate or their behavior, attitude or appearance to be unacceptable.
I hereby certify that all statements made in this application are true, complete and without omission. I authorize investigation of all matters represented by this application. I agree and understand that any misstatements or omission of material fact on this application will cause forfeiture on my part of all rights of becoming an instructor with the Fair Oaks Recreation & Park District no matter when said misstatements or omission is discovered or comes to light. I also
authorize employers, schools, or persons from employers or past contacts where classes were once taught to give any information regarding my employment, qualifications and character. I hereby release said employers, schools or past contacts where classes were once taught and the Fair Oaks Recreation and Park District from any liability or damages for receiving using or releasing information.