Health Run LLC

1
Full Name* This field is required.
First Name
Last Name
2
Current Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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Other
Country
3
Email Address* This field is required.
example@example.com
4
Phone Number* This field is required.
5
Applying for Position* This field is required.
Please Select
Please Select
Medical Courier
EMT
Both
6
Are you legally authorized to work in the United States?* This field is required.
Yes
No
7
Do you have a reliable, insured vehicle?* This field is required.
Yes
No
8
Vehicle type?* This field is required.
Car
SUV
Van
Truck
9
Year / Make / Model* This field is required.
10
Is your vehicle in good working condition and suitable for delivery?* This field is required.
Yes
No
11
What year is your vehicle?* This field is required.
12
Do you carry active auto insurance?* This field is required.
Yes
No
13
Are you willing to provide proof of insurance?* This field is required.
Yes
No
14
Do you have previous medical courier or delivery experience?* This field is required.
Yes
No
15
If yes, how many years?
16
Have you ever handled medical specimens or time-sensitive deliveries?* This field is required.
Yes
No
17
Are you familiar with HIPAA compliance and privacy requirements?* This field is required.
Yes
No
18
Are you familiar with chain-of-custody procedures?* This field is required.
Yes
No
19
Have you worked as a 1099 independent contractor before?* This field is required.
Yes
No
20
What days are you available? (Mon–Sun)
21
What hours can you work?
22
Are you available for STAT/emergency deliveries?* This field is required.
Yes
No
23
Are you available for overnight or early-morning routes?* This field is required.
Yes
No
24
Do you consent to a background check?* This field is required.
Yes
No
25
Do you consent to a motor vehicle record (MVR) check?* This field is required.
Yes
No
26
Do you have any restrictions on your driver’s license?* This field is required.
Yes
No
27
Do you have any pending traffic violations?* This field is required.
Yes
No
28
Are you able to lift up to 30–50 lbs if required?* This field is required.
Yes
No
29
Do you have a smartphone capable of using route/delivery apps?* This field is required.
Yes
No
30
Are you familiar with using GPS, routing apps, and delivery tracking software?* This field is required.
Yes
No
31
Do you have reliable mobile data?* This field is required.
Yes
No
32
Are you comfortable interacting with hospital/clinic staff?* This field is required.
Yes
No
33
Are you able to maintain professionalism during sensitive deliveries?* This field is required.
Yes
No
34
Do you have any medical or logistics certifications?* This field is required.
Yes
No
35
Start date
Date
Month
Day
Year
36
Upload Car Insurance* This field is required.
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37
OSHA Certificate* This field is required.
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38
HIPPA Certificate* This field is required.
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