Trusted Diagnostics Contractor Network

What type of contractor opportunity are you interested in?* This field is required.Select all that apply

Medical Assistant Contractor

Patient Care Contractor

Both

Name* This field is required.

First Name

Last Name

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone Number* This field is required.

Area Code

Phone Number

Email* This field is required.

example@example.com

Preferred Contact Method* This field is required.

Phone

Text

Best Time to Contact* This field is required.

Morning

Afternoon

Evening

Anytime

What best describes your current professional status?

Independent Contractor

Self-Employed

Currently employed elsewhere

Currently seeking work

Other

How did you hear about Trusted Diagnostics?

Facebook

Instagram

Indeed

Google

Referral

Trusted Diagnostics Website

Flyer / QR Code

Other

Do you currently perform independent-contractor work for another company?* This field is required.

YESNO

If Yes, What type of work?

Counties you are willing to serve

Wayne County

Oakland County

Macomb County

Other Michigan Counties

Primary Service Area* This field is required.

Maximum Travel Distance* This field is required.

Are you willing to travel outside of your primary service area?

YESNO

What days are you generally available?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What times are you generally available?

Early morning

Morning

Afternoon

Evening

Overnight

Flexible

How much notice do you generally need?* This field is required.

Are you interested in receiving short-notice assignments?

YESNO

Do you have reliable transportation?

YESNO

Do you have a valid driver's license?

YESNO

Do you maintain required automobile insurance?

YESNO

What type of vehicle do you primarily use?

Are you comfortable traveling to homes, businesses, healthcare facilities, pharmacies, laboratories, and other assignment locations?

YESNO

Do you have a smartphone?

YESNO

Can you receive:

Phone Calls

Text Messages

Emails

Mobile assignment notifications

Are you comfortable using mobile applications for assignments?

YESNO

Are you comfortable uploading assignment documentation electronically?

YESNO

How quickly can you generally respond to an assignment?

Are you currently credentialed/certified as a phlebotomy professional?

YESNO

Phlebotomy Credentials

Credential Type

Certifying Organization

Certification/Credential number

Expiration Date

Years of Phlebotomy Experience

Phlebotomy ExperienceSelect all that apply

Venipuncture

Capillary Collection

Pediatric Collection

Geriatric Collection

Difficult draws

Mobile/Home Collections

Employer Collections

Facility Collections

Specimen processing

DNA Collections

Drug-Testing Collections

Other

Have you performed mobile phlebotomy services?

YESNO

How long have you performed mobile phlebotomy services?

Do you have access to the equipment necessary for assignments you accept?

YESNO

Equipment/technology experience

Smartphone

GPS/navigation

Centrifuge

Temperature-control equipment

Phlebotomy Supplies (Needles, Bandages, Tourniquets, etc.)

Bio-Hazard Containers

Disposable gloves, Hand sanitizer etc.

Other

Scenario 1A client is nervous about having blood collected. How would you handle the situation?

Scenario 2You arrive at a mobile assignment and the client is not available. What would you do?

Scenario 3 You anticipate being late to an assignment. What steps would you take?

Scenario 4You are unable to successfully obtain the specimen after appropriate collection attempts. What would you do?

Scenario 5What steps do you take to protect client/patient confidentiality?

Have you previously worked as a courier?

YESNO

Years of courier/delivery experience

Types of Delivery Experience

Medical

Laboratory specimens

Pharmacy / Prescription Delivery

Medical Supplies / Equipment

General courier

Documents/ Records

Other

Have you worked with:

Specimen Pickup

Laboratory delivery

Pharmacy pickup/delivery

Type option 4

Temperature-sensitive materials

Chain-of-custody procedures

Pickup documentation

Delivery documentation

Route logs

Other

Describe your courier experience

Do you have access to the equipment necessary for assignments you accept?

YESNO

Equipment/technology experience

Smartphone

GPS/navigation

Insulated transport containers

Temperature-control equipment

Delivery documentation

Scanning/barcode technology

Other

Scenario 1You arrive at a pickup location and the package/specimen is not ready. What would you do?

Scenario 2You realize you may be late for a scheduled delivery. What would you do?

Scenario 3You arrive at a location and the receipt is unavailable. What would you do?

Scenario 4You notice that required pickup information does not match the assignment information. What would you do?

Scenario 5Why is maintaining specimen/package security and confidentiality important?

Applicant Acknowledgements* This field is required.I understand that submitting this application does not guarantee acceptance into the Trusted Diagnostics Independent Contractor Network or guarantee assignments.

I understand that I am applying for an independent-contractor opportunity and not a traditional employee position.

I understand that submitting this application does not guarantee acceptance into the Trusted Diagnostics Independent Contractor Network or guarantee assignments.

I understand that assignments may be offered based on business needs, client requirements, geographic location, qualifications, availability, and other applicable criteria.

I understand that I am responsible for maintaining accurate information and keeping required credentials, insurance, licenses, and other documentation current.

I understand that additional documentation and verification may be required before I can receive assignments.

I certify that the information I have provided is true and accurate to the best of my knowledge.

Electronic Signature* This field is required.

Date

Trusted Diagnostics Contractor Network