Independent Contractor Application

Independent Contractor Application

Roadside Service Technician Agreement
Personal Information

Please enter your Personal Information. When you have finished, select "Next" to continue to the next section of the application. By signing and submitting this application, you are acknowledging that the Independent contractor relationship described in the agreement section, is contingent upon completion of the screening process. Furthermore, you are acknowledging consent to a local and federal background check and motor vehicle history report. Any information obtained will be used for that purpose only.
Full Name*

First NameMiddle NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Social Security Number*
Must contain 9 digits
Are you legally authorized to work in the United States?*
Valid Driver’s License *
Driver’s License ever suspended or revoked*
Years of Driving Experience*

0 - 3 year3 - 5 yearMore than 5 yrsMore than 10 yrs
Driver’s License Number*
Issue Date*

MonthDayYear
Expiration Date*

MonthDayYear
Please explain any driving violations, accidents, injuries, or incidents in the last 5 years. List dates of any incidents.*
Please upload a clear photocopy of your Driver’s License*

Cancelof
Please upload a clear photocopy of your current proof of insurance*

Cancelof
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
How long at Current Address? *
Start Date of Residency*

MonthDayYear
Date
Previous Address (If at current address less than 3 years)

Street Address

Street Address Line 2

CityState

Zip Code

Employment History

Please enter the information requested for your work experience. Press &quot;Submit&quot; when you have finished.
Upload Resume

Cancelof
Years of Roadside Service Experience*

0 - 2 year3 - 4 yearMore than 4 yrs
What Metro Area would you like to Service?*
Please provide a statement explaining why you are a good candidate to become a roadside partner. (Experience, certifications, etc.)*
What is your general availability to provide roadside assistance services?*
Currently Employed?*
Current or Previous Employer Details*

Employer Name

Street Address

CityState

Phone Number
Position:*
Employment Start Date*

MonthDayYear
Employment End Date

MonthDayYear
Reason for Leaving*
Supervisor*

First NameLast Name
May we contact this employer? If yes, list the phone number and/or email. If not, please explain.*
Previous Employer

Employer Name

Street Address

CityState

Phone Number
Employment Start Date

MonthDayYear
Employment End Date

MonthDayYear
Reason for Leaving
Supervisor

First NameLast Name
Appendix A: Detailed Description of Services

Vehicle Lockouts:

The Contractor shall provide assistance to customers who have accidentally locked themselves out of their vehicles. This service includes using appropriate tools to unlock doors without causing damage to the vehicle.

Battery Jump Services:

Contractor will perform battery jump-start services to assist customers with dead vehicle batteries. This involves safely connecting jumper cables to the customer's vehicle battery and providing the necessary power to start the engine.

Spare Tire Change Services:

In the event of a flat tire, Contractor will replace the flat tire with the spare tire. This service includes safely removing the flat tire, installing the spare tire, and ensuring proper tire inflation.

Fuel Delivery Services:

The contractor will deliver a specified quantity of fuel to customers who have run out of gas. This service includes safely refueling the customer's vehicle at the location of the breakdown.

These services will be performed efficiently and professionally, adhering to safety standards and guidelines. The Contractor is expected to provide excellent customer service and represent Wichita Area Roadside LLC and it's affiliates in a positive manner during service delivery.

Appendix B: Policies & Procedures

1. Vehicle Lockouts:

   a. Procedure:

      - Use appropriate tools to unlock doors without causing damage.

      - Verify customer identification and vehicle ownership.

      - Document the service provided and obtain customer acknowledgment.

   b. Safety Protocol:

      - Prioritize safety during door unlocking procedures.

      - Follow established safety guidelines to avoid accidents or damage.

2. Battery Jump Services:

   a. Procedure:

      - Safely connect jumper cables to the customer's vehicle battery.

      - Ensure correct polarity when attaching cables.

      - Verify the proper functioning of the vehicle after the jump.

   b. Safety Protocol:

      - Adhere to safety standards for handling batteries and electrical components.

      - Provide safety instructions to customers during the process.

3. Spare Tire Change Services:

   a. Procedure:

      - Safely remove the flat tire and install the spare tire.

      - Ensure proper lug nut tightening according to vehicle specifications.

-Be attentive to stripped lug nuts, taking utmost care to avoid breaking studs. Know when to cancel if studs pose a risk. Always verify spare tire pressure for accuracy.

      - Check the spare tire's inflation level.

   b. Safety Protocol:

      - Utilize safety equipment when handling heavy objects.

      - Educate customers on safe tire-changing practices.

4. Fuel Delivery Services:

   a. Procedure:

      - Deliver the specified quantity of fuel to the customer's location.

      - Confirm the correct fuel type and amount.

      - Provide information on fueling safety to customers.

- Please note, we don't deliver diesel. Ensure fuel costs are collected if the customer isn't covered.

   b. Safety Protocol:

      - Follow proper fueling procedures to prevent spills and hazards.

      - Use appropriate safety gear and equipment during fuel delivery.

General Safety Protocol:

Our target is 0. Aim for zero accidents, injuries, incidents, and claims. Safety is our top priority.

Daily Equipment and Vehicle Inspections:

   - Conduct daily inspections of all equipment and vehicles used for roadside assistance.

-ALWAYS WEAR A Safety Vest

   - Check for any signs of damage, wear, or malfunction.

   - Verify the availability and functionality of safety equipment.

   - Document inspection results and report any issues promptly.

   - Ensure routine maintenance is performed to keep equipment and vehicles in optimal condition.

General Policies:

1. Customer Interaction:

   - Maintain a professional and courteous demeanor when interacting with customers.

   - Communicate effectively and provide clear instructions to customers.

2. Record Keeping:

   - Document all services provided, including customer information and service details.

   - Maintain accurate records for billing and reporting purposes.

3. Uniform and Identification:

   - Wear the designated uniform and display proper identification while on duty.

   - Project a professional image representing the client.

4. Timeliness:

   - Respond promptly to service requests and adhere to scheduled appointments.

   - Keep customers informed in case of delays.

5. Documentation:

-Capture the job process with before and after pictures for thorough records.

6. Locating Customers:

Use various methods, including sharing locations through Apple-to-Apple phones, mapping via apps like Google Maps, and others.

These policies and procedures are designed to ensure the efficient and safe operation of Wichita Area Roadside LLC's roadside assistance services. All personnel are expected to familiarize themselves with and adhere to these guidelines.
May we contact this employer? If yes, list the phone number and/or email. If not, please explain.

Independent Contractor Agreement

This Independent Contractor Agreement ("Agreement") is entered into as of [screening approval date], by and between Mid America Strategy Hub LLC ("Company"), on behalf of Wichita Area Roadside LLC, doing business as Metro Area Roadside and [the undersigned contractor] ("Contractor").

Services:

Contractor shall work as a light-duty roadside assistance technician, providing services including vehicle lockouts, battery jump services, spare tire change services, and fuel delivery services. The detailed description of these services is outlined in Appendix A.

Compensation:

The compensation for this 1099 Independent Contractor position has a starting range of 20.00% to 30.00% of the income from services performed by the contractor. The exact commission rate will be determined based on the contractor's skills, experience, performance, and volume of work.

Payments will be processed monthly on the 15th of each month and will be facilitated by Mid America Strategy Hub LLC.

The contractor is entitled to the commission when proof of services have been documented via the electronic system provided by the company, client, or affiliate of the company.

Indepenent Scheduling:

This position operates on a pay-for-performance model with flexible on-call, PRN scheduling options.

Contractor Status:

The Contractor has control over how they achieve their sales or business goals, works independently, and not be under the direct supervision or control of the company like an employee would be.

No Guaranteed Minimum:

Independent contractors do not receive a guaranteed minimum wage or salary. Their income is solely based on the commissions they earn.

Tax Responsibilities: Contractors are responsible for their own taxes, including income taxes and self-employment taxes. The hiring entity (company or staffing agency) does not withhold taxes from commission payments, so the contractor must manage their own tax obligations.

Background Check:

Contractor consents to the Company or client of the company conducting background and motor vehicle reports as part of the screening process.

DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES.

Disclosure: Wichita Area Roadside LLC may request from a consumer reporting agency and for employment-related purposes, a “consumer report(s)” (commonly known as “background reports”) containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). HireRight, LLC (“HireRight”) will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 100 Centerview Drive, Suite 300, Nashville, TN 37214, (800) 400-2761, www.hireright.com. The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information. I hereby authorize Company to obtain the consumer reports described above about me.

Insurance and Registration:

Contractor must maintain valid automobile insurance and vehicle registration, providing proof as requested.

Company Policies:

Contractor agrees to adhere to all Company policies and procedures. Detailed policies and procedures outlined in Appendix B.

Cancellation:

Either party may cancel any part of this Agreement within 30 days with written notice.

Equipment:

Equipment may be provided as needed, however the contractor retains control over how the work is performed, and the provision of equipment does not alter their independent status. Equipment is provided as a convenience rather than a requirement.

In the event of cancellation, the Contractor must promptly return all Company equipment within 7 days. Failure to do so may result in credit reporting and/or legal action.

Governing Law:

This Agreement shall be governed by and construed in accordance with the laws of [Kansas].

Entirety:

This Agreement constitutes the entire understanding between the parties and supersedes all prior agreements, whether written or oral.

Name*

First NameLast Name
Date*

MonthDayYear
By signing and submitting this application, you are acknowledging that the independent contractor relationship described in the agreement section, is contingent upon completion of the screening process. DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES Disclosure: Wichita Area Roadside LLC (the “Company”) may request from a consumer reporting agency and for employment-related purposes, a “consumer report(s)” (commonly known as “background reports”) containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). HireRight, LLC (“HireRight”) will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 100 Centerview Drive, Suite 300, Nashville, TN 37214, (800) 400-2761, www.hireright.com. The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information. I hereby authorize Company to obtain the consumer reports described above about me.*

Powered by Jotform SignClear
Should be Empty:

Independent Contractor Application

Personal Information

Employment History