M2Z Compliance Solutions
A Division of M2Z Holdings, LLC
PREFERRED NETWORK
Provider Enrollment Form
Join the M2Z Preferred Network — we connect CDL drivers and owner-operators completing their DOT Return-to-Duty process with trusted SAPs, employers, and recruiters. Fill out this short form to apply. Takes under 2 minutes.
STEP 1—WHO ARE YOU? (Check one)
Who are you?
SAP Substance Abuse Professional performing DOT evaluations
Employer Trucking company or fleet hiring CDL drivers
Recruiter Staffing professional placing CDL drivers
STEP 2—CONTACT INFORMATION
Full Name
Company / Practice Name If independent, write 'Independent'
Phone
Format: (000) 000-0000.
Email
example@example.com
City & State
Website or LinkedIn Optional
STEP 3—WHAT YOU DO
If SAP—check all that apply:
Initial SAP Evaluation
Follow-Up Evaluation
Education / Treatment Referral
RTD Recommendation & Documentation
Follow-Up Testing Plan (Step 6)
Evaluation Fee Flat rate charged to driver
Report Turnaround Business days to written report
If Employer — check all that apply:
Actively hiring CDL-A drivers
Actively hiring CDL-B drivers
Open to RTD-cleared drivers
Owner-Operator leases available
Local / Regional routes
OTR / Long-haul routes
Fleet Size Approx. number of trucks/drivers
Positions Open Now Approximate number
If Recruiter — check all that apply:
CDL-A Drivers
CDL-B Drivers
Owner-Operators
Company Drivers
Regional / OTR
Local / Last Mile
M2Z Compliance Solutions | info@m2zcompliance.com | Suwanee, Georgia
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M2Z Compliance Solutions
A Division of M2Z Holdings, LLC
PREFERRED NETWORK
Provider Enrollment Form
States / Regions Covered e.g., Southeast, GA, FL, TN
Avg. Placements Per Month Approximate number
STEP 4— AVAILABILITY & PREFERENCES
How do you prefer to receive referrals from M2Z?
How do you prefer to receive referrals from M2Z?
Email
Phone / Text
Online Form / Portal
Best Time to Reach You e.g., Mon-Fri 9am-5pm
Same-Week / Urgent Availability? Yes / No / Sometimes
STEP 5— SIGN & SUBMIT
By signing I confirm that:
The information above is accurate and complete
consent to M2Z contacting me with referrals and network updates
I understand inclusion does not guarantee volume, exclusivity, or payment from M2Z
Inclusion in the M2Z Preferred Network does not constitute a partnership, employment relationship, or financial agreement with M2Z Compliance Solutions or M2Z Holdings, LLC.
Printed Name
Date MM/DD/YYYY
-
Month
-
Day
Year
Date
Signature
Date
SUBMIT THIS FORM
Email to: info@m2zcompliance.com
Online at: www.m2zcompliance.com
FOR OFFICE USE ONLY
Date Received:
Type:
SAP
Employer
Recruiter
Approved
Pending
Denied
Preview PDF
Submit
Should be Empty: