Jewish Community Center in Manhattan

1099 Information Form

To be completed by all 1099s:

Employee Name_______________________________________________________

Address______________________________________________________________

Telephone ________________ Home E-mail ________________________________

Birth date ________________ Social Security # ____________________________

For ongoing/multi-session 1099s please add the following:

Name of Emergency Contact _____________________________________________

Phone ___________________ Relationship ________________________________

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To be completed by JCC Supervisor:

Dept / Code ______________________

Start Date___/___/____ Supervising Staff Member____________________________

Mo. day year

To your knowledge, does this person currently work in other JCC departments?______

Other Depts. ________________________________

Has this person previously worked at the JCC? ____________________________

Does job include fitness access? _________________________________________

Supervisor: Please submit with Independent Contractor Agreement & W9 Form.

You must sign below to indicate your agreement with the details of this appointment as
indicated above.

Comments ____________________________________________________________

_____________________________________________________________________

Authorized by:______________________________________ Date _______________