Independent Contractor Application

Name (Required)*

First Last

Business Name (if applicable):

Address (Required)*

Street Address Address Line 2 City State ZIP Code

Phone (Required)*

Email (Required)*

Website address (if applicable)

Contract Program Information

Program Name (Required)*

Program Description (how it would look when advertised): (Required)*

Please provide a sample curriculum.

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 60 MB, Max. files: 3.

What season would the program be available? (Required)*

Please note Summer is NOT Available for Contract Programs.

Winter/Spring (January - April)

Fall (August - December)

What day(s) of the week would the program be available? (Required)*

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What time of day would the program be offered? (Required)*

Morning

Mid-Day

Afternoon

Evening

What age group(s) would the program target? (Required)*

Infant/Toddler

Preschool

School Age

Teen

Adult

Senior (50+)

Minimum number of participants per class (Required)*

Maximum number of participants per class (Required)*

Staff to participant ratio (Required)*

Per participant fee required by contractor (specify if per class, session, season, etc.) (Required)*

Facility and Equipment/Supplies Information

Describe what type of facility is required. Be sure to include specifics about type of web access, monitors, sound, floor, lighting, location, etc. (Required)*

Is storage required? (Required)*

Yes

If YES, please describe storage requirements. Be sure to include examples of what will be stored, for how long, approximate size of space needed, proximity to program, etc.

What supplies/equipment are provided by participant:

What supplies/equipment are provided by contractor:

What supplies/equipment/administrative assistance would you like provided by Ken-Caryl Ranch:

Instructor Information

Summarize any special education, training, certifications, skills and qualifications YOU possess (please provide copies of certificates in the upload section):

Certificates

Please upload any certificates for you or your staff here.

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 50 MB, Max. files: 5.

Summarize any special education, training, certifications, skills and qualifications YOUR INSTRUCTORS must possess (please provide copies of certificates in the upload section):

Please explain how you recruit, hire, and train your instructors to ensure they are qualified to teach or lead programs.

Do you conduct background checks on employees? (Required)*

Yes

Have you ever been convicted of any law violation?*

Include any pleas of "guilty" or "no contest". Exclude minor traffic violations.

Yes

If yes, give details. A conviction will not necessarily disqualify an Independent Contractor

What motivated you to contract with Ken-Caryl Ranch? What do you hope to gain from this collaborative partnership?

References

Please list three references for which you have performed similar contractual duties (no family members). Include Name, Title, Organization Name, Address, Phone, Email and Years Known for each. (Required)*

Please review the SAMPLE Independent Contractor Agreement at this link:

Sample Independent Contractor Agreement

Signature*

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING. I have reviewed the SAMPLE Independent Contractor Paperwork linked above and can fulfill all listed requirements. By my signature below I affirmatively represent that I am able to perform the functions of the position for which I have described in the application. I understand that all information furnished here may be verified. I authorize all individuals and organizations named in this application to release supporting information relative to such verification, and release such sources and the Ken-Caryl Ranch Metropolitan District from liability for any claim that may result. By signing below, I consent to the above statements.

Do you agree to storage of your data?*

By submitting this form, you hereby agree that we may collect, store and process your data that you provided.

Yes

Independent Contractor Application