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State Form Number (SFN) 58394

Instructions for Independent Contractor Verification Application Form

Instructions for SFN 58394

The North Dakota Department of Labor and Human Rights is authorized by N.D.C.C. § 34-05-01.4 (15kb pdf) to verify the independent contractor status of future or existing work relationships in the state. While verification is not mandatory for parties wishing to work as or hire independent contractors, it is available on a voluntary basis to workers and firms who would like to receive a formal verification from the State as to the status of their work relationship.

Parties who would like an independent contractor verification of their work relationship may complete the Independent Contractor Verification Application (SFN 58394). The form is designed to be completed by the worker and then submitted to the firm for its review, notation of any additional information the firm may wish to include, and signature. Once input and review from both parties is received, as evidenced by the signatures of both parties, the form should be sent to the North Dakota Department of Labor and Human Rights.

In addition to reviewing beginning and existing work relationships as noted above, the department has authority to determine the status of existing or previous work relationships when necessary within the context of investigating a claim for unpaid wages. In these instances, a separate Independent Contractor Verification Application is completed by both the wage claimant and the person against whom the claim was filed.

 

  • 600 East Boulevard Ave
  • Dept 406
  • Bismarck ND 58505-0340
  • (701) 328-2660
  • 1-800-582-8032 - In-state toll-free
  • 1-800-366-6888 or 1-800-366-6889 - TTY (Relay ND)
  • (701) 328-2031 Fax