Independent Contractor Application — Dillingham Consulting

1APPLICATION INFORMATION

Date of application

Date available to start

Service / role applying for *

Engagement type desired *

Expected hours per week

Services offered / areas of expertise *

2BUSINESS & PERSONAL INFORMATION

Independent Contractor Notice: As an independent contractor, you are responsible for your own taxes, insurance, and benefits. Engagement is governed by a separate Independent Contractor Agreement.

Business information Optional

Complete this part only if you operate under a business name, LLC, or DBA. If you work under your own name, skip ahead to Personal information — every field in this part may be left blank.

Business / company name

Business type

EIN (if applicable)

Business website / portfolio

Personal information Required

All applicants must complete this part, whether or not you operate under a business entity.

Last name *

First name *

Middle initial

Street address *

City *

State *

ZIP *

Date of birth *

Cell phone *

Email address *

Other languages

Are you 18 or older? *

Yes No

How did you hear about us? *

Internet Referral LinkedIn Other

3WORK AUTHORIZATION

Legally authorized to work in the US? *

Yes No

Are you currently engaged with other clients? *

Yes No

4EMERGENCY CONTACT

Who should we contact in the event of an emergency while you are working an assignment?

Contact name *

Relationship *

Contact phone *

Alternate phone

5CONTRACT / PRIOR WORK HISTORY (Most Recent First)

List your most recent contract engagements or prior employment, whichever best reflects your experience. Both are acceptable.

Contract / Position 1 — Most Recent

Client / employer name

Contact / phone

Address

City, State, ZIP

Role / services provided

Start date

End date

Engagement type

Description of work performed

Contract / Position 2

Client / employer name

Contact / phone

Address

City, State, ZIP

Role / services provided

Start

End

Engagement type

Description of work performed

Contract / Position 3

Client / employer name

Contact / phone

Address

City, State, ZIP

Role

Start

End

Engagement type

6EDUCATION

Level	School name *	Course of study / Major *	Completed? *	Graduation year
High School
College / University
Other

7LICENSES, CERTIFICATIONS & SPECIALIZATIONS *

List every active license, certification, or specialization relevant to this role. If you do not hold any, check the box below.

I do not hold any licenses or certifications

License / Certification / Specialization	Issuing body / ID number	Expiration	State

8PROFESSIONAL REFERENCES

Please provide at least two professional references — preferably former clients or colleagues who can speak to your work quality.

Reference 1 — Name

Company / organization

Phone / email

Reference 2 — Name

Company / organization

Phone / email

Reference 3 — Name

Company / organization

Phone / email

9RESUME / PORTFOLIO UPLOAD

Attach a current copy of your resume or portfolio. Your file is submitted with this application — it is not used to fill in the fields above.

📄

Upload your resume / portfolio (optional)

PDF, DOC, DOCX, or TXT — max 10MB. Drag & drop or click to browse.

10CERTIFICATION & SIGNATURE

I certify that all information provided in this application is true and complete. I understand that as an independent contractor I am not an employee and am responsible for my own taxes, insurance, and compliance. I understand that submission of this application does not guarantee engagement and that any contract is subject to a separate Independent Contractor Agreement.

Type your full name as signature *

Typing your name constitutes a legal digital signature.

Date *

By submitting you confirm all information is accurate. Your application will be saved securely.

✅

Application submitted!

Thank you for your interest in contracting with us. We'll review your application and be in touch within 3–5 business days.

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