If you are an out-of-state independent contractor (or an in-state Arizona independent contractor) hired by Certified Paramedic Response, LLC (CPR), then these are forms that you need to complete:

  • Employment Eligibility (I9) Form – Sections 1 & 2
  • Federal W4 Form
  • Workman’s Comp Exclusion for Subcontractors
  • Direct Deposit Authorization
  • Work Capacity Test Health Screening Forms (Appendix B, et. al)
  • Informed Consent Form (Appendix B)

Please select a form to begin. We recommend Reading These Instructions first:

If you are an out of state independent contractor (or in state Arizona independent contractor) hired by Certified Paramedic Response, LLC, there are three forms that need to be completed.

Mike Planeta, Owner and Operator of Certified Paramedic Response, LLC

1. Federal W-4 Form –

This is a simple form to complete required by the IRS.

1a. Box 1 requires your name or business name.

1b. Box 3 is asking for a checkmark, if you are coming in as an “individual” meaning you have not set up a separate business as an independent contractor, checkmark the first box that says “Individual/sole proprietor or single-member LLC.” Otherwise, checkmark the entity type of your business.

1c. Box 5 and 6 – address

1d. Fill in Part 1 with either your social security number (if you are coming in as an individual) or your employer identification number (if you have setup a business).

1e. Sign and date the form

2. Employment Eligibility Form (I9) –

Section 1 – Full Name, Other Last Names Used, Home Address, Apartment, City or Town, State, ZIP Code, U.S. Social Security Number, E-mail Address and/or Telephone Number, Attestation of Your Citizenship (either you’re a citizen, a noncitizen national of the U.S., lawful permanent resident, or an alien authorized to work). If you’re a lawful permanent resident, provide your 7- to 9-digit Alien Registration Number (A-Number), including the “A,” or USCIS Number. Aliens authorized to work must enter one of the following to complete Section 1:

  • Alien Registration Number (A-Number)/USCIS Number; or
  • Form I-94 Admission Number; or
  • Foreign Passport Number and the Country of Issuance.

Your employer may not ask you to present the document from which you supplied Alien Registration information.

Section 2 – Provide either of the following documentation:

3. As an independent contractor –

As an independent contractor coming in from out of state or in the state of Arizona, you are responsible for your own workmen’s compensation policy. Please sign the waiver form stating that you are not an employee and are responsible for your own workmen’s compensation policy if you choose to insure yourself.

4. Direct Deposit (DD) Authorization Form –

Please complete and sign this form so that we can pay you.

Don’t forget to Track your Expenses!

Don’t forget to keep track of your receipts an expenses pertaining to your business as an independent contractor. You will receive a full payment without any tax withholdings. In January of the following year CPR, LLC will issue a Form 1099-NEC to you, with which you can report to your tax return. There are situations where the IRS requires backup withholding, CPR, LLC will let you know if they receive a notice from the IRS pertaining to you specifically which requires backup withholding.

When you’re ready, please select a form to begin:

Course Content