United Courier IC Application

Todays Date	Saturday, October 05, 2024	I have a question

	First	Last
Your Name
	Street Address	Apt#, Suite, Room#
Address
	City	State	Zip
City, State, Zip		Ohio Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Home Phone
Cell Phone
Email Address

License#

SS Number

Date of Birth

Age

Vehicle Year

Make

Model

Miles

Any body damage or needed repairs?

Any chargeable accidents in the last 5 years?

If yes, how many? and dates

Any moving violations in the last 5 years?

If yes, how many? and dates

DUI or DWI Conviction?

If Yes, Date?

Have you ever been self-employed?

If Yes explain

Any delivery service experiance?

Any customer service experiance?

Can you read a map or use apps such as Google Maps or Waze?

How long have you lived in the Cincinnati Area?

Years

Are you interested in Fulltime or Parttime availability?

Full Time

Are you available for nights or weekends?

Why are you interested in being an
IC driver for United Courier?

How soon are you available to start?

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