Contractor Application Company Name(Required)Position(Required)Personal Information:Full Name(Required) First Middle Last Date of Birth(Required) MM slash DD slash YYYY Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Contact MethodPhoneEmailTextDriver InformationDo you have a valid Driver's License? Yes No Have you ever been convicted of a driving-related offense (e.g., DUI, Reckless Driving)? Yes No If yes, please explain:Have you ever had your license suspended or revoked? Yes No If yes, please explain:Vehicle InformationWhat type of vehicle do you drive?CarVanTruckSUVMotorcycleOther (Please specify)Vehicle Make and ModelVehicle YearVehicle License Plate NumberIs your vehicle insured? Yes No Is your vehicle registered? Yes No Work AvailabilityWhich days are you available for work?MondayTuesdayWednesdayThursdayFridaySaturdaySundayWhat is your preferred working hours (please specify the range of hours you’re available)?How many hours per week are you available to work?Do you have any preferences regarding the types of deliveries you would like to do? (i.e., food, packages, heavy deliveries, etc.)Experience and ReferencesDo you have previous experience as a delivery driver? Yes No If yes, please describe your experience:Please list any relevant skills or certifications (e.g., GPS, safety courses, handling large packages, etc.):ReferencesNamePhoneRelationship:NamePhoneRelationship:Tax & Legal InformationAre you legally eligible to work in the United States?(Required) Yes No Are you currently a 1099 contractor for other companies?(Required) Yes No Do you have a registered business or DBA (Doing Business As) name?(Required) Yes No If yes, please provide the name of your business:Acknowledgments and SignatureI understand that as a 1099 independent contractor, I am responsible for my own taxes and will receive a 1099 form at the end of the year for tax reporting.(Required) Yes No I consent to a background check as part of the application process.(Required) Yes No I verify that all information provided in this application is true and accurate to the best of my knowledge.(Required) Yes No Signature(Required)Date(Required) MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
