Application Form | County Couriers

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Courier Driver / Independent Contractor Application

Please complete and submit the form below to be considered for contracting opportunities through our team.

Name *

First

Middle

Last

Street Address

City

State

Zip Code

Please list your vehicle year/make/model

Valid State Drivers License number:

Phone Number (Please include area code)

Email Address *

Position Applied For

Are you a citizen of the United States?

Yes
No

If no, are you authorized to work in the U.S.?

Yes
No

Have you ever worked for this company?

Yes
No

If so, when?

Highest Level of Education

College Degree
Some College
High School Diploma
Some High School
Other

Reference 1 Full Name *

First

Last

Reference 1 Relationship

Reference 1 Company

Reference 1 Phone Number

Reference 2 Full Name *

First

Last

Reference 2 Relationship

Reference 2 Company

Reference 2 Phone Number

Reference 3 Full Name *

First

Last

Reference 3 Relationship

Reference 3 Company

Reference 3 Phone Number

PREVIOUS EMPLOYMENT

Company 1

Supervisor Name *

First

Last

Job Title

Supervisor Phone

Responsibilities

Employed from:

Employed to:

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

PREVIOUS EMPLOYMENT 2

Company 2

Supervisor Name *

First

Last

Job Title

Supervisor Phone

Responsibilities

Employed from:

Employed to:

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

PREVIOUS EMPLOYMENT 3

Company 3

Supervisor Name *

First

Last

Job Title

Supervisor Phone

Responsibilities

Employed from:

Employed to:

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Do you have 100/300 Liability Insurance?

Yes
No

If yes, please list your Insurance company and coverage type

Are you willing to undergo a criminal background check?

Yes
No

By checking yes, I certify that my answers are true and complete to the best of my knowledge. If this application leads to an vendor contract, I understand that false or misleading information or interview may result in my release. *

Yes
No

Today's Date

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