Drive for the best custom delivery service in Cleveland. We specialize is delivering for the medical industry and are always looking for courteous and conscientious drivers who like being challenged. Simply fill out the application below and click “Submit”. If you have any questions, please Contact Us.

NicaIncorporated

INDEPENDENT CONTRACTOR PROFILE FORM

(PLEASE PROVIDE A PHOTOCOPY OF YOUR SOCIAL SECURITY CARD)

(PLEASE PROVIDE PHOTOCOPY OF DRIVER LICENSE)

Type of entityIndividual/Sole proprietorCorporationPartnershipLLC

ATTACH A COPY OF YOUR MVR OBTAINED IN THE LAST 30 DAYS FORM THE BMC OR REGISTRYAUTO INFORMATION

PLEASE PROVIDE CURRENT CERTIFICATE OF INSURANCE FOR AUTO POLICY.

WORK HISTORY LIST YOUR TWO MOST RECENT JOBS/CONTRACTS YOU HAVE HAD.
DECLARATIONTo the best of my knowledge the above information is accurate and truthful . I understand that i am completing this information in order to contract my services as a self-employed independend Contractor and not as the employess of and company.

DISCLOSURE UNDER FAIR CREDIT ACT
CONSENT TO PROCURMENT OF
CUNSUMER REPORT FOR
INDEPENDENT CONTRACTOR PURPOSES

The undersigned herby authorizes the Clockwork logistrics, Inc. Or its insurance agency Evarts Tremaine, or its assigns , To obtain copies of consumer reports , including a motor vehicle report , pertaining To me for Contractor purposes , and for use in rationg and / or underwriting insurance for which the above named Company may apply , and any renewal thereof,I understand that in obtaining such consumer reports, a consumer reporting agency may be used, and I do hereby authorize such use.

PLEASE NOTE * MINIMUNINSURANCE REQUIREMENTS FOR INDEPENDENT SUB-CONTRACTORS IS AS FOLLOW.***$100,000/$300,000***

Or download, print and mail this form (click here) to: 4765 E 131st St, Garfield Heights, OH 44105