• Independent Contractor Questionnaire: Driver

  • This questionnaire is to ensure you are the right fit for this position, and to make sure that you have all the requirements to be contracted within TransMedCare.

     By signing below I agree and acknowledge the above statements.

  • For insurance purposes, are you 25-years or older?*
  • Can you legally work in the United States?*
  • Are you willing to authorize a background, employment verification, drug test (upon contract), and MVR check in accordance with local law and regulations?*
  • Can you reliably commute to TransMedCare's location?*
  • Are you available to commit 5-10 consecutive days per trip? This means you are not coming back to Orlando on a daily basis.*
  • Are you comfortable traveling the 48 continental states and flying in an airplane?*
  • Are you comfortable driving in snow and using snow chains?*
  • Do you have experience driving cargo van or a heavier type of vehicle?*
  • Are you allergic to pets?*
  • Are you able to lift 100lbs assisted?*
  • Are you able to read, write, and understand English?*
  • Do you understand that as an independent contractor, you would not be eligible for unemployment benefits at the end of any contract with TMC?*
  • Do you understand that as an independent contractor, you would be responsible for payment of any and all state and/or federal income taxes, Social Security, self-employment taxes, unemployment taxes, and payroll taxes and that you will receive a form 1099 for service provided to TMC by you?*
  • Have you ever been contracted with TransMedCare (TMC) before?*
  • Did someone refer you for this independent contractor service?

  • You will have to provide the following documents that are required to be contracted with TransMedCare. Not needed at this time, but will be needed after the screening process:

    • Valid Driver's License (required)
    • DOT Medical Certificate (required)
    • PASS Certificate (required)
    • Defensive Driving Certificate (required)
    • LLC Registration (optional)
    • Workers' Compensation Exempt (optional)

  • This certifies that this questionnaire was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

  • Date:*
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