Career Name/Business Name:Address:Cell PhoneEmail Address Business ID or Social Security Number:Do you use your U.S. Social Security Number as your Business Federal ID Number? Yes No Did you receive an IRS Form 1099 for performing services in the last year? Yes No Briefly describe the nature of the services you perform that you are currently licensed for:Please provide all services you offer:Professional License & Certifications (New York State license, CPR, etc.):Professional References (Last 2 employers/contractors contact information):Have you ever been convicted or accused of a crime in the past 10 years? (If so, please describe)How did you hear about our business?Attestation and Certification: 1. I am a citizen of the U.S. or a permanent resident. 2. I am not an employee or otherwise affiliated with Glamour Village INC. 3. If Glamour Village INC hires me as an independent contractor, I understand that I am responsible for taxes, insurance coverage, and business expenses, and that I am not eligible for any employer-provided benefits. An agreement outlining this relationship will be provided.SignatureDate MM slash DD slash YYYY Print Name:Title:Fill out the Request for Taxpayer Identification Number and Certification Click HereFile(Required)Max. file size: 512 MB.
