Driver Form - Life Couriers

Contact Information

Name

First

Last

Full legal first name required.

Email

Phone

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Qualification Details

Are you authorized to work in the United States?

Yes
No

Do you consent to be contacted by Life Couriers regarding potential driving opportunities?

Yes
No

Do you own a business with EIN?

Yes
No

If YES, enter your business name and state of formation here:

Which of the following vehicles do you own?

If you own a second vehicle, select it here

What is the year, make and model of your vehicle(s)?

Select your vehicle fuel type

Do you have a valid Driver's License?

Yes
No

Do you have a CDL (commercial driver's license)?

Yes
No

Driver's License Details: What class?

A
B
C
D / Standard (non CDL)

Driver's License Details: What endorsements?

Hazmat
None

Driver's License Details: Do you have an Active DOT Med Card?

Yes
No

How many days per week are you available to drive contract work?

What days of the week are you NOT available to drive contract work?

What specific hours are you NOT available to driver contract work?

Are you willing to drive throughout your home state for contract work?

Yes
No

Are you willing to drive to other states on contract routes?

Yes
No

Do you have two or less moving violations on your driving record in the past 36 months from today's date?

Yes
No

Are you willing to submit to a background check and drug screening to be considered for a contract opportunity?

Yes
No

business operates States?

Are you able to complete our pre-contracting tasks (background check, drug screening, online training modules, and contract management platform enrollment) within 2 business days?

Yes
No

We cover the background screening costs upfront and then charge independent contractors back for up to $80 on their first commission settlement/earning. Are you willing to cover the cost of your background screenings in this way?

Yes
No

While we understand that recreational cannabis usage is legal in some states, Life Couriers operates under Federal DOT regulations, and a positive result will disqualify you from our contracts - even with a medical use card. Please acknowledge:

I would qualify
I DO NOT qualify

Authorisation

I authorize Life Couriers to store my details and to contact me in the future about suitable opportunities, upon submitting this form.

Contractor Courier
Submission Form

Contractor Courier Lead Submission Form

Contact Information

Qualification Details