Independent Contractor Application (1099)

Independent Contractor Application (1099)

Please complete this application fully and legibly. The information provided will be used to determine your suitability to contract with Muncie Equipment Rentals (MER).
Name*

First NameLast Name
Birth Date

MonthDayYear
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Info
Are you legally authorized to work in the United States?*

YesNo
Have you served in the U.S. Armed Forces?*

YesNo
If yes, please list branch, years of service, and type of discharge:
Do you have a valid Driver’s License?*

YesNo
License Number/State/Exp. Date
Type/Endorsements
e.g. Operator, Commercial (CDL)
Copy of driver’s license (to verify ID and driving eligibility):

Cancelof
Do you have any moving violations, DUIs, or license suspensions in the past 5 years?*

YesNo
If yes, please explain:
Do you have your own truck capable of hauling trailers/equipment up to 14,000 lbs?*

YesNo
Proof of auto insurance (shows you're covered while driving):

Certificate of Insurance (COI) or a copy of your insurance card
Cancelof
Do you have experience performing basic maintenance on heavy equipment/trailers?*

YesNo
Education / Training
Select all that apply

High School / GEDCollege / Trade SchoolOther Training
Schools/Training Attended
Training and Certifications
Work History (Last 5 Years)

Please list all relevant contracting or work experience.
Work History #1
Work History #2
Work History #3
Work History #3
Work History #3
Resume and Files (Optional)

Cancelof
Have you ever been terminated or released from a contract?

YesNo
If yes, please explain:
Have you ever been convicted of a crime (excluding expunged/sealed records)?

YesNo
If yes, please explain:
Are you comfortable following checklists and protocols for equipment pickup/delivery?

YesNo
Do you maintain your work area, vehicle, and equipment in clean and professional condition?

YesNo
Are you able to work early mornings, evenings, or weekends if required?

YesNo
References

Please list two (2) references that are familiar with your work life.
Reference
Reference
Acknowledgment

I certify that the information provided is true and complete. I understand that:

This application is for independent contractor work only.
Submitting this application does not guarantee work with Muncie Equipment Rentals.
As an independent contractor, I will not be considered an employee of MER and will not be entitled to employee benefits.
Any work performed will be under a written Independent Contractor Agreement, outlining compensation, responsibilities, and requirements.
Signature*
Date*

MonthDayYear
Date
Should be Empty: