Join Our Team | Milagro Medical Logistics

1

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Home Address (Street, City, State, ZIP) *

Date of Birth *

Social Security # (Last 4 digits only)

2

Driver's License & Vehicle

Driver's License Number *

State of Issue *

License Expiration Date *

License Class *

Do you have any violations, suspensions, or DUIs in the last 5 years? *

No violations Yes — please describe below

If yes, please describe

Vehicle Make *

Vehicle Model *

Vehicle Year *

Vehicle Color

License Plate Number *

Plate State

Vehicle VIN

Vehicle Type *

Sedan / Hatchback SUV / Crossover Cargo / Passenger Van Pickup Truck

Does your vehicle have auto insurance? *

Yes No

Insurance Provider

Policy Number

Insurance Expiration Date

Coverage Amount

3

Work Authorization & Background

Are you legally authorized to work in the United States? *

Yes No

Do you consent to a background check? *

Yes, I consent No

Do you consent to a Motor Vehicle Record (MVR) check? *

Yes, I consent No

Have you ever been convicted of a felony? *

No Yes — please describe

If yes, please describe (conviction does not automatically disqualify)

4

Certifications & Qualifications

Which of the following certifications do you currently hold? (Check all that apply)

Bloodborne Pathogens (OSHA) DOT Hazardous Materials HIPAA Privacy & Security USP <800> / Chemotherapy Transport TSA PreCheck TWIC Approved CPR / First Aid None currently

Are you willing to obtain required certifications if not already held? *

Yes No

List any other relevant certifications or training

5

Availability & Experience

What days are you available to work? (Check all that apply)

What shifts are you available for?

Morning (6am – 12pm) Afternoon (12pm – 6pm) Evening (6pm – 12am) Overnight (12am – 6am) On-Call / STAT (any hour)

Are you available for 24/7 STAT emergency calls? *

Yes No

How many years of courier or delivery experience do you have? *

Do you have prior medical courier or healthcare logistics experience?

Yes No

Describe your relevant experience

Do you have experience transporting any of the following? (Check all that apply)

Laboratory Specimens Blood Products Pharmaceuticals Hazardous / Chemo Drugs Human Organs / Tissue Medical Equipment None of the above

6

Independent Contractor / 1099 Information

Do you operate under a business entity?

Yes (LLC, sole proprietor, etc.) No — individual

Business Name (if applicable)

EIN / Tax ID (if applicable)

Do you understand this is a 1099 independent contractor position (not W-2 employment)? *

Yes, I understand No, I have questions

Preferred payment method

Direct Deposit Check Zelle / Digital

7

Professional References

Please provide two professional references (not family members) who can speak to your reliability and work ethic.

Reference 1 — Name *

Relationship *

Phone Number

Email Address

Reference 2 — Name

Relationship

Phone Number

Email Address

8

Additional Information

How did you hear about us? *

Do you have a smartphone with GPS and data capabilities? *

Yes No

Is there anything else you'd like us to know about your qualifications or availability?

9

Agreements & Certification

By submitting this application, I certify that all information provided is true and accurate to the best of my knowledge. I understand that any false statements may result in disqualification or termination. I consent to background checks, MVR checks, and reference verification as part of the screening process. I acknowledge that submission of this application does not guarantee an offer of work.

I certify that all information in this application is true, complete, and accurate. I consent to background, MVR, and reference checks. I understand this is a 1099 independent contractor position and that I am responsible for my own taxes, insurance, and equipment. I agree to comply with all HIPAA, OSHA, DOT, and company policies if selected to work with Milagro Medical Logistics.

Drive With Milagro
Medical Logistics

1099 / Independent

Atlanta Metro Area

Flexible Scheduling

Meaningful Work

Personal Information

Driver's License & Vehicle

Work Authorization & Background

Certifications & Qualifications

Availability & Experience

Independent Contractor / 1099 Information

Professional References

Additional Information

Agreements & Certification

Requirements Checklist

Questions?

Application Received!

Drive With MilagroMedical Logistics

1099 / Independent

Atlanta Metro Area

Flexible Scheduling

Meaningful Work

Personal Information

Driver's License & Vehicle

Work Authorization & Background

Certifications & Qualifications

Availability & Experience

Independent Contractor / 1099 Information

Professional References

Additional Information

Agreements & Certification

Requirements Checklist

Questions?

Application Received!

Drive With Milagro
Medical Logistics