* READ FIRST *

  • Please note that if the entire form is not completed correctly, an entirely new form must be completed.
  • Please ensure all signatures are legible and name must match your driver’s license.
  • Please first properly label the required documents for upload below:
    • All attachments below must be a .pdf, .doc, .docx, .png, .jpg, or .jpeg and file size less than 5mb. (how to reduce file size?)
    • Resume of the contractor, company owner or qualifying agent
      • Please label “Resume – NAME”
    • Personal licenses of contractor, company owner or qualifying agent
      • Please label “(State) License (or LEO) – NAME”
    • Company license for contract security services and/or investigations
      • Please label “Company (State) License – NAME”
    • General Liability Certificate of Insurance (COI) (if applicable)
      • Please label “GL – NAME”
    • Workers Compensation Certificate of Insurance (COI) (if applicable)
      • Please label “WC – NAME”
  • Complete these documents: 
  • Once the form below is completed, when you click ‘SUBMIT FORM’ a green confirmation box will appear.
    • Anything else other than a green confirmation box is an error message, one or more fields have an error. Please check and try again.

    Full Name*
    (Legal Name - Must Match Driver's License)

    Company Name (if applicable)
    (Legal Name - Must Match W9)

    Phone*

    Email*

    Address

    3 References (Employers) with approval for us to contact them*
    (company name, point of contact name and phone, your position and when)

    Security / Investigations License(s) with State, Number and Expiration Date. (If none leave blank)

    Agree to Duties and Term (Yes/No)*
    The Independent Contractor’s duties, term of engagement, and provisions for payment thereof shall be as set forth in the estimate previously provided to LaSorsa & Associates by the Independent Contractor or which is otherwise provided by LaSorsa & Associates and mutually agreed to by the Independent Contractor. The term is considered "at will" with no expectation or implied obligation of length of or from the Company to the Independent Contractor.
    "Yes" is a required response as an Independent Contractor.

    Equipment (Yes/No)*
    The Independent Contractor agrees to provide at his or her own expense the required equipment for the agreed scope of work, which may include but not limited to: a smartphone with data plan, two-way radio, uniform items and conformity, a reliable means of transportation, a laptop computer, etc.
    "Yes" is a required response as an Independent Contractor.

    Agree to Nondisclosure and Confidentiality (Yes/No)*
    The Independent Contractor agrees that [he or she] will not disclose any of the trade secrets, inventions, innovations, processes, information, records and specifications owned or licensed by the Company, directly or indirectly, or use any of them in any manner, either during the term of this Agreement or at any time thereafter, except as required in the course of this engagement with LaSorsa & Associates.
    "Yes" is a required response as an Independent Contractor.

    Eligibility to Enter Contract / Non-Hire Provision (Yes/No)*
    A positive response (Yes) is required to indicate you are eligible to enter a contract with LaSorsa and Associates, and not bound by any other contractual obligations or non-compete which would prevent you from being eligible to work for LaSorsa and Associates.
    "Yes" is a required response as an Independent Contractor.

    Understanding of Worker's Compensation Requirement (if applicable) (Yes/No)*
    The Contractor understands that the Company requires all independent contractors to have their own Worker's Compensation coverage and if they do not provide a certificate as instructed or the certificate is invalid or expired, the Company may withhold 3% of gross payments.
    "Yes" is a required response as an Independent Contractor.

    IC has completed a Payment Preference Form (Yes/No)*
    "Yes" is a required response as an Independent Contractor.
    (Payment Preference Form is linked above)

    Please upload your resume*
    Please label "Resume - NAME"

    Please upload your security/investigations license(s) and/or LEO Credential*
    Please label "(State) License (or LEO) - NAME"

    Please upload your company license(s) if applicable
    Please label "Company (State) License - NAME"

    Please upload your general liability insurance certificate (if applicable) (GL and WC are required for companies)
    Note a required field - if none, leave blank
    Please label "GL - NAME"

    Please upload your worker's comp insurance certificate (if applicable) (GL and WC are required for companies)
    Note a required field - if none, leave blank
    Please label "WC - NAME"

    Signature* (must be legible and match name above)
    "My signature below confirms my agreement to the terms presented and to the temporary, 'at-will' independent contractor relationship between myself (the Independent Contractor) and LaSorsa & Associates; I am to receive payment up to 60 days post invoice upon project completion with approved expenses reimbursed; I must provide my own personal equipment; I have no claim to benefits such as sick or vacation pay or leave, worker’s compensation, health or disability benefits, unemployment insurance benefits, or employee benefits of any kind; I am subject to IRS Form 1099 and I must provide a W-9; I will indemnify and hold-harmless LaSorsa & Associates and its affiliates, officers, directors, employees, agents, successors and assigns from and against all losses, damages, liabilities, deficiencies, actions, judgments, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorneys' fees, arising out of or resulting from bodily injury, death or damage to real or tangible personal property resulting from acts or omissions as well as any breach of any representation, warranty or obligation under this Agreement; I accept the choice of law for any discrepancy, settlement or otherwise is the state of Florida."

    Click below to submit your form.