Courier Application
Independent Contractor Position
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Current City
*
Current Zip Code
*
Are you age 21 or over?
*
Yes
No
Do you own your own vehicle?
*
Yes
No
Vehicle Year / Make / Model
*
Is this vehicle insured with 100/300 liability coverage?
*
Yes
No
Availability
*
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AM
PM
Overnight
N/A
What date can you start?
*
-
Month
-
Day
Year
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We transport a wide variety of items for our customers that will include medical specimens and lab work, COVID-19 tests/samples, etc. Are you interested in becoming certified as a Medical Courier?
*
Yes
No
Are you comfortable with transporting medical specimens which will include COVID-19 tests?
*
Yes
No
Please list any other qualifications that you have and which you believe should be considered.
Submit
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