Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a valid driver’s license? *

Yes

No

Do you have a reliable vehicle? *

Yes – Sedan

Yes – SUV

Yes – Van

No

Do you have current auto insurance? *

Yes

No

How many days per week are you available to deliver?

1–2 days

3–4 days

5+ days

Flexible / Open availability

What days are you typically available?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Do you have any experience delivering packages, medications, or lab specimens?

Yes – professionally

Yes – for gig platforms (e.g., Instacart, Amazon Flex, etc.)

No, but I’m ready to learn

Are you willing to complete HIPAA and BBP training? *

Yes

No

Do you have any criminal convictions that would prevent you from handling sensitive deliveries? *

Yes

No

I understand that this is a 1099 independent contractor position, and I will be responsible for my own taxes. *

Yes