Independent Contractor Application

1
What position are you applying for?* This field is required.
Port Escort (Current TWIC Card Holder)
Dispatcher Staff
2
Which location are you interested in working at?* This field is required.
Morehead City, NC
Wilmington, NC
South Carolina
Virginia
Remote (Dispatch Staff Only)
3
What is your full legal name?* This field is required.
4
What is your date of birth?* This field is required.
Date
Year
Month
Day
5
What is your social security number?* This field is required.Required for tax purposes.
6
What is your current home address?* This field is required.Please include address, city, state, and zip code
7
What is your mobile phone number?* This field is required.
Please enter a valid phone number.
8
What is your email address?* This field is required.
example@example.com
9
What is your daily availability?* This field is required.
Full Time Availability (M-F 8AM to 4PM)
Part Time Availability
10
If Part Time, please list your weekly availabilityie. Monday 12-4, Tuesday 8-12...
Huge
Large
Normal
Small
Ok
Ok
11
When does your TWIC Card expire?
Date
Year
Month
Day
12
Upload a copy of your TWIC Card
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
13
What is your Driver's License/State ID number?* This field is required.
14
Which state is your Driver's License/State ID from?* This field is required.
15
When does your Driver's License/State ID expire?* This field is required.
16
Upload a copy of your Driver's License/State ID * This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
17
Who should we contact in case of an emergency? (Full Name)* This field is required.
18
What is your emergency contact's phone number?* This field is required.
Should be Empty: