Independant Contractor Application

Quick Application

Upload Resume*
Drop files here or
Max. file size: 5 MB.
Company Name
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Consent*
- I understand while contracting for Haloprime, I’m expected to have a working smartphone, with a data plan that I pay for. Haloprime is not responsible for the cost of my mobile products or services.
- I understand I am an independent contractor, and not an employee of Haloprime.
- I understand Haloprime can request random drug/alcohol screenings. To continue contracting work through Haloprime, compliance is mandatory.
- I understand that as an independent contractor, I am responsible for my own taxes and will receive a 1099 from Haloprime at the end of the year.
- I will follow all state laws, OSHA and DOT regulations.
- I understand that while contracting for Haloprime, I'm expected to wear a Dish Network/Haloprime approved uniform, including badge and shirt with logos and “Authorized Contractor.”
- I understand I am responsible for any and all equipment issued to me, and am responsible for any damage or loss to equipment Haloprime has supplied me.
- I understand I will be paid weekly on all work orders completed and invoiced, once work orders are reconciled.
Date*
MM slash DD slash YYYY
Signature*
Consent*
I consent to the background check.
This is to inform you that Haloprime Inc. may request a consumer report from consumer reporting agencies in connection with your application for joining Haloprime Inc. as an Independent Contractor. Any information contained in these reports may be taken into consideration while evaluating your application.
For Haloprime purposes, a consumer report consists of criminal history records, motor vehicle records, education and independent contract employment verification.
If it appears likely an adverse decision regarding your association with Haloprime Inc might be made based entirely or in part on information contained in these reports, you may be notified of this possibility before a final decision is made. At that time, you will be provided with a copy of any consumer reports Haloprime Inc., has requested on you, as well as a summary of your rights.
Your consent is required by law for the release of this information. Your signature on this form indicates you have carefully read and understand this notice and authorizes the release of a consumer report to Haloprime Inc, for the purposes described above.
Date*
MM slash DD slash YYYY
Signature*
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Independent Contractor Application

Step 1 of 7 - Contact Information

Name*
First Last
EIN/SS#*
Business Name (if applicable):
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*

Emergency Contact*
Phone*
Relationship*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you ever been convicted of a crime?*
Explain Below. Yes doesn't disqualify you for consideration.
Are you under 18 years of age?*
Have you ever been convicted of a felony?*
Have you ever been convicted of driving under the influence?*

Previous Work History
Upload Resume*
Drop files here or
Max. file size: 5 MB.
Does Your Resume Include Your Work History?*
Position Title
Description/Duties
Company
Address
Phone
Supervisor
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Position Title
Description/Duties
Company
Address
Phone
Supervisor
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Position Title
Description/Duties
Company
Address
Phone
Supervisor
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY

Education & Certification
Highest Level Completed*
Graduation Date*
MM slash DD slash YYYY
Name of Institution*
Address
Certifications Held

Business Information (If applicable)
What type of business are you?
What type of Professional Business Licenses do you currently operate under, if any?
Insurance Coverage
Liability Insurance Company
Policy #
Expiration
Workers Compensation Company
Policy #
Expiration
Auto Insurance
Policy #
Expiration

Disclosures
Please check each box below if you've read and understood.
Consent*
- I understand while contracting for Haloprime, I’m expected to have a working smartphone, with a data plan that I pay for. Haloprime is not responsible for the cost of my mobile products or services.
- I understand I am an independent contractor, and not an employee of Haloprime.
- I understand Haloprime can request random drug/alcohol screenings. To continue contracting work through Haloprime, compliance is mandatory.
- I understand that as an independent contractor, I am responsible for my own taxes and will receive a 1099 from Haloprime at the end of the year.
- I will follow all state laws, OSHA and DOT regulations.
- I understand that while contracting for Haloprime, I'm expected to wear a Dish Network/Haloprime approved uniform, including badge and shirt with logos and “Authorized Contractor.”
- I understand I am responsible for any and all equipment issued to me, and am responsible for any damage or loss to equipment Haloprime has supplied me.
- I understand I will be paid weekly on all work orders completed and invoiced, once work orders are reconciled.
Date*
MM slash DD slash YYYY
Signature*
Independent Contractor - Consent for Background Check*
I agree to the background check.
This is to inform you that Haloprime Inc. may request a consumer report from consumer reporting agencies in connection with your application for joining Haloprime Inc. as an Independent Contractor. Any information contained in these reports may be taken into consideration while evaluating your application.
For Haloprime purposes, a consumer report consists of criminal history records, motor vehicle records, education and independent contract employment verification.
If it appears likely an adverse decision regarding your association with Haloprime Inc might be made based entirely or in part on information contained in these reports, you may be notified of this possibility before a final decision is made. At that time, you will be provided with a copy of any consumer reports Haloprime Inc., has requested on you, as well as a summary of your rights.
Your consent is required by law for the release of this information. Your signature on this form indicates you have carefully read and understand this notice and authorizes the release of a consumer report to Haloprime Inc, for the purposes described above.
Date*
MM slash DD slash YYYY
Signature*
Please provide a copy of your current driver’s license and Social Security Card for Owner or Authorized Official with this authorization.
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Quick Application

Independent Contractor Application

Step 1 of 7 - Contact Information

Previous Work History

Education & Certification

Business Information (If applicable)

Insurance Coverage

Disclosures

Address

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