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Affidavit of Independent Contractor Status

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Title:Affidavit of Independent Contractor Status
Summary:July 2006 Form for CompSource Oklahoma
Description:
Keywords:
Handle: Document-894
Owner: Finance Office  (User-16,  fit:DocuShare)
Create Date:Monday, August 21, 2006 02:58:50 PM CDT
Modified Date:Thursday, December 20, 2007 04:39:09 PM CST
Modified By: Finance Office  (User-16,  fit:DocuShare)
Expiration Date:
Locked By:
Abstract:
  • Note: Employers who knowingly and willfully require an employee or subcontractor to execute an affidavit when the employer knows that the employee or subcontractor is required to be covered under a workers’ compensation insurance policy shall be liable for a civil penalty of up to $1,000.00 per offense.
  • 9.
  • I understand that knowingly providing false information on an Affidavit of Exempt Status Under the Workers’ Compensation Act shall constitute a misdemeanor punishable by a fine not to exceed One Thousand Dollars ($1,000.00).
  • __________________________________ My Commission Expires: _____________My Commission # ______________ Notary Public ****GIVE THE SIGNED FORM TO YOUR GENERAL ...
Add Versions:Allowed
Author:
Content Type: Adobe Portable Document Format (.pdf) - application/pdf
File name:workers comp aff.pdf
Is Placeholder:
Max Versions:4
Size:34003
Ready for Declare:No
Appears In: Workers' Compensation - Documents to assist churches with workers' compensation compliance.
Preferred Version: Affidavit of Independent Contractor Status