Independent Contractor Application
Personal Information
Full Name
*
First Name
Middle Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
''Used for identity verification and background screening purposes only.”
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Driver Information
Do you have prior courier experience?
Yes
No
Do you have a experience with medical deliveries?
Yes
No
Do you have a valid DOT medical card? (optional) (Only needed if operating heavy vehicle/CDL driver. )
Yes
No
Vehicle Information
Vehicle Make
*
Vehicle Modle
*
Vehicle Year
*
License Plate Number
*
Do you have a valid drivers license?
*
YES
NO
Vehicle Type (Car, SUV, Van, Truck)
*
If you have more than one vehicle please specify in the "additional information" option below.
Business Inforamtion
Do you operate under a registered business?
*
Yes
No
Business Name:
*
Please enter the EIN (if applicable)
upload business registration or LLC certification (optional)
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Compliance
Are you legally eligible to work in the U.S?
*
YES
NO
Do you consent to a background check? (By selecting yes, you authorize Buddies Courier LLC to conduct background and verification checks)
*
YES
NO
Availability
Available Hours Per Week
Available Work Days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Insurance Information
Insurance Company
*
Policy Expiration Date
Photo Of Driving License (Your driving license photo will be securely used for verification purposes only and will not be shared with third parties.)
*
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Photo Of Car Insurance
*
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Signature
By Signing This Application You Agree That You Filled Out This Application To Your Best Knowledge.
Signature
*
By submitting this application, the applicant(you) authorizes Buddies Courier LLC to review the provided information and documents for the purpose of determining eligibility to perform courier services.
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