READ THIS 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.
  • All attachments must be a .pdf, .doc, .docx, .png, .jpg, or .jpeg and less than 3mb. (how to reduce file size?)
  • Please first download, prepare and properly label the required documents:
    • 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 Insurance
      • Please label “GL – NAME”
      • Must list ‘LaSorsa and Associates 101 VFW Rd Suite 2E Cedar Point, NC 28584’ as a certificate holder
    • Workers Compensation Insurance
      • Please label “WC – NAME”
      • Must list ‘LaSorsa and Associates 101 VFW Rd Suite 2E Cedar Point, NC 28584’ as a certificate holder
    • A completed and signed independent contractor agreement. 
    • A completed and signed W9. 

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

Company Name
(Legal Name - Must Match W9)

Phone

Email

Address

Driver's License State and Number

Current Employer(s) and Current Position

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

Previous Independent Contractor for L&A? (Yes/No) When?

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

Active/Retired LEO? Include Credential/Badge Number and Agency (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.

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.

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.

Eligibility to Enter Contract / Non-Hire Provision (Yes/No)
A positive response 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.

Understanding of Worker's Compensation Requirement (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 5% of gross payments.

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 (GL and WC are required for companies)
Please label "GL - NAME"
Must list LaSorsa and Associates 101 VFW Rd Suite 2E Cedar Point, NC 28584 as a certificate holder.

Please upload your worker's comp insurance certificate (GL and WC are required for companies)
Please label "WC - NAME"
Must list LaSorsa and Associates 101 VFW Rd Suite 2E Cedar Point, NC 28584 as a certificate holder.

Please upload a completed and signed IC Agreement (all pages)
Download Agreement Here: https://www.lasorsa.com/wp-content/uploads/2019/09/LA-IC-Agreement-9-5-19.pdf
Please label “ICA - NAME”

Please upload a completed and signed W9 (signature page only)
Download W9 Here: https://www.lasorsa.com/wp-content/uploads/2019/04/W9-form.pdf
Please label “W9 - 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."