Spacelinks Drivers Enrollment Form

SPACELINKS

NEMT Independent Professional Drivers Enrollment Form
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Rideshare Driving Experience

List all rideshare and car service companies you worked for
UBER*

ActiveDeactivatedWaiting listI don't have an Uber account or never signed up
Number of trips completed*
LYFT*

ActiveDeactivatedWaiting listI don't have a Lyft account or never signed up
Number of trips completed*
List all Access-A-Ride companies you worked for*
Documents
DMV Driver's License Number*
Copy of DMV Driver's License Number *
TLC Driver's License Number*
Copy of TLC Driver's License *
TLC Diamond Sticker Number*
Copy of TLC Diamond Sticker *
DMV Vehicle Registration*
DMV Inspection Sticker *
TLC License Plate Number*
Picture of TLC License Plate*
TLC Insurance (FH1) Policy Number*
Name of Insurance Company*
Copy of TLC Insurance Card (FH1 Page)*
Copy of TLC Certificate of Insurance*
Copy of TLC Insurance Declaration Page*
Picture of the TLC vehicle *
Disclaimers
** Important Notice**

Spacelinks LLC is a licensed NYC TLC base/dispatch facility. Spacelinks does not own, lease, maintain, or operate vehicles and does not employ drivers. Affiliated drivers and fleets are independent businesses that maintain their own vehicles, permits, and FH-1 insurance. Any transportation service is performed solely by those independent providers.

** This is NOT a Promise to Hire**

Submitting this form does not constitute a promise or a committement to hire you or partner with you by SPACELINKS. Each application will be evaluated and considered based on the company's vehicle's needs. If the required number of vehicles is fullfilled, your application will be placed on waiting list. If you get waitlisted, you'll be contacted based on the order your application is received shall we need to enroll more vehicles.

** SMS Sign-up and Opt-In.**

By submitting this form, you consents to receive text messages from the company for advertising purposes related to its services, promotions, or relevant updates. Message frequency varies. Unsubscribe any time by replying STOP.

** Privacy Policy.**

Please consult https://www.spacelinks.us/privacy-policy for more information on the use of your personal information.
Signature*

Powered by Jotform SignClear
Should be Empty:

SPACELINKS

Rideshare Driving Experience

Documents

Disclaimers