Personal Information
First Name
Last Name
Street Address
City
State ZIP
Home Phone
Nextel Cell Phone #
Date of Birth
Example: 00/00/0000
SSN
Example: 000-00-0000
E-mail Address
Are you employed now?
Yes No
Vehicle
Vehicle Make
Model
Year
Tag # State
Mileage
Insurance Company
Agent's Name
Phone
Address
City
State Zip
Policy Number
Employment History
A. Last Employer
Address
City
State Zip
Phone
Manager
Length of Employment
Title
Reason for leaving
B. Previous Employer
Address
City
State Zip
Phone
Manager
Length of Employment
Title
Reason for leaving
Job References
A. First Name
Last Name
Street Address
City
State Zip
Home Phone
Work Phone
B. First Name
Last Name
Street Address
City
State Zip
Home Phone
Work Phone
C. First Name
Last Name
Street Address
City
State Zip
Home Phone
Work Phone
Please Answer the Following Questions "Yes" or "No"
Yes No
A. Are you a U.S. Citizen?
Yes No
B. Do you have a valid driver's license?
Yes No
C. Do you have more than 3 points against your driving record?
Yes No
D. Do you like driving?
Yes No
E. Is your vehicle in sound mechanical condition for this type of work?
Yes No
F. Is your address the same as indicated on your driver's license?
Yes No
G. Do you have full coverage insurance on your vehicle you will be using?
Yes No
H. Is the vehicle registered in your name?
Yes No
I. Do you know the Charleston-Mt. Pleasant-Summerville Area?
Yes No
J. Do you know how to read a map book?
Yes No
K. Have you ever been a courier before?
Yes No
L. Have you ever dispatched before?
Yes No
M. Are you available for weekly rotation on call services?
Yes No
N. Our services are available 24/7/365; do you have a problem with this?
Yes No
O. Are you able to find an address with little or no help using local resources?
Yes No
P. If you were lost, would you use a Fire Department for directions?
Yes No
Q. If you were lost, would you use a Police Department for directions?
Yes No
R. If you were lost, would you call your spouse or a friend for directions?
Yes No
S. Could J. Jones 350 Main Street be the same as J. Jones 350 South Main Street?
Yes No
T. If a One Hour delivery is going to be late, is the dispatcher the first to be notified?
Yes No
U. You have six deliveries, 2 hours left before closing time. Do you ask for help?
Yes No
V. Do you really want to work with our company?
Understanding of and Binding Agreement:
By submitting this application I acknowledge that the above information is true and accurate to the best of my knowledge. I hereby authorize ABC Courier to contact the references noted on this application to verify my work history and background. I hereby authorize ABC Courier to complete the necessary background/criminal checks, including DMV reviews and driving history. I authorize my insurance agent listed on this application to release any/all information to ABC Courier concerning my vehicle and its coverage. Should I be selected as an IC Courier for ABC Courier, I agree to commit to ABC for a term no less than 90 days of service. If such commitment is incomplete, I hereby agree to compensate ABC Courier for any/all cost associated with training, setup fees, background check completions and any other fees owed by ABC Courier.
Upon agreement of applicant and ABC Courier, this contract will be signed at the interview.