Medical Courier Job Application

Medical Courier Job Application

Thank you for your interest in joining Let’s Go Proactive Solutions. Please complete this form to be considered for courier opportunities. We are seeking professional, dependable drivers for medical and last-mile deliveries.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Do you have a valid driver’s license?*

YesNo
What type of vehicle will you use for deliveries?*
Do you have any of the following?*

Pallet JackLiftgateTrailerOther:
Do you have prior delivery or courier experience?*

YesNo
If yes, please briefly describe your relevant experience.
What is your general availability?*

MondayTuesdayWednesdayThursdayFridaySaturdaySundayMorningsAfternoonsEveningsOvernightOn-Call/EmergencyOther
Are you legally permitted to work in the United States?*

YesNo
Are you willing to submit to a Background Check, MVR Check and Drug Screening?*

YesNo
Do you have any Certifications below?*

HIPPABLOODBORNE PATHOGENSTWICCDL ACDL BHAZMATNONE OF THE ABOVEOTHER
I understand that drivers for Let’s Go Proactive Solutions operate as independent contractors and not employees.**

YesNo
Emergency Contact Name*
Relationship to Emergency Contact*
Emergency Contact Phone Number*
Please enter a valid phone number.
Should be Empty: