Delivery Driver Form
Please complete the form below to apply for a position with us.
Full Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
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2015
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2012
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1920
Year
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Your Phone Number
*
Cell Service Provider
*
Ex. AT&T, Verizon, Sprint
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Address
*
Street Address
City
State / Province
Postal / Zip Code
Emergency Contact Phone Number
*
Please enter a valid phone number.
Please select day(s) & time(s) you are available to deliver
*
Mon 11-3
Mon 3-6
Mon 6-9
Tue 11-3
Tue 3-6
Tue 6-9
Wed 11-3
Wed 3-6
Wed 6-9
Thur 11-3
Thur 3-6
Thur 6-9
Fri 11-3
Fri 3-6
Fri 6-9
Sat 11-3
Sat 3-6
Sat 6-9
Have you ever been convicted of a felony? Yes or NO (If Yes Please Explain)
*
Vehicle Year
*
Ex 2015
Vehicle Make
*
Ex Toyota
Vehicle Model
*
Ex Camry
License Plate Number
*
Vehicle VIN
*
Upload Your Drivers License
*
Browse Files
Drag and drop files here
Choose a file
Please scan a copy of your drivers license and upload it here
Cancel
of
Upload Your Proof of Insurance
*
Browse Files
Drag and drop files here
Choose a file
Please scan a copy of your vehicle proof of insurance and upload it here
Cancel
of
W9 Form
Complete this form as it will be used to complete the actual W9 From for the IRS
1. Name as shown on your tax return
*
2. Business Name/disregard entity name, if different from above
3. Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the seven boxes
*
Individual/sole proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/Estate
Limited Liability Company
Other
4. Address (number, street & apt. or suite no.)
*
Street Address
City
State / Province
Postal / Zip Code
Social Security Number
*
T-Shirt Size
*
Small
Medium
Large
Extra Large
2 X Lagre
3 X Large
How did you hear about us
*
Please Select
Facebook
Instagram
Google
Current Delivery Driver
Other
Authorization & Acknowledgement: I hereby authorize Kentucky Takeout to obtain my MVR to verify the above information. I further authorize that my record may be verified periodically at Kentucky Takeout's discretion & I understand that if my record at any time does not meet company requirements, my status as a Kentucky Takeout delivery driver may be removed. I authorize the investigation of all statements herein. I further authorize all listed references to give you any & all information concerning my previous employment & pertinent information they may have, personal or otherwise; & release all parties from any liability that may result from furnishing the same to you.
*
Yes
No
I acknowledge that I have read the qualification requirements for a qualified Delivery Driver & that I will have the opportunity to review those qualifications with a manager at Kentucky Takeout. I understand the Delivery Driver qualifications & further understand that failure to meet these qualifications shall disqualify me as a Delivery Driver. I also understand that I must have Liability insurance covereage while performing services for customers & that Kentucky Takeout is not responsible for any physical injuries/damage to me, my vehicle and/or any other parties involved.
*
Yes
No
I understand the importance of safety & agree to the following safety polices while driving: 1) To only drive the insured car listed above for deliveries. 2) To keep my car in safe working order & always wear my seat belt. 3) To place food bags & drinks in the prescribed area of the vehicle. 4) To never drive after having consumed drugs or alcohol. 5) To not allow anyone else to ride in the vehicle while performing duties for the customer. 6) To obey all laws & follow all traffic rules & regulations at all times. 7) To notify Kentucky Takeout immediately if issued a traffic citation. 8) To notify Kentucky Takeout if my driving privileges become suspended, restricted or revoked. 9) To notify Kentucky Takeout with any changes in insurance policy & coverage.
*
Yes
No
I certify that the facts contained herein are true and complete to the best of my knowledge & understand that false statements on this form may be grounds for termination of my independent contractor services. I acknowledge that if a restaurant or service chooses to enlist my services as a Delivery Driver, I will have to sign that companie's Delivery Driver Independent Contractor Agreement prior to performing any services. (Sign with your mouse or finger if you have touch screen)
*
Submit
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