Join Our Team | Milagro Medical Logistics

1

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

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

Primary Market *

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 Straight Truck Motorcycle

How many vehicles do you have available for courier work?

Cars / Sedans

Cargo / Passenger Vans

SUVs / Trucks

Straight Trucks

Are your couriers professional in appearance? *

Yes No

Are you IAC (Indirect Air Carrier) Certified by the TSA?

Yes — I can provide documentation No

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

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

DOT / Regulatory Credentials

Enter your credential numbers below or select N/A. All fields must be completed before submission.

USDOT Number *

If you operate under your own USDOT authority. Type N/A if not applicable.

MC Number (Motor Carrier Authority) *

FMCSA Motor Carrier number. Type N/A if not applicable.

CDL Number *

Commercial Driver's License number. Type N/A if you do not hold a CDL.

CDL Class (if applicable)

CDL State of Issue (if applicable)

CDL Expiration Date (if applicable)

Do you have any DOT violations or out-of-service orders on record? *

No Yes — I will provide details

7

Independent Contractor / 1099 Information

Do you operate under a business entity?

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

Business Name (if applicable)

DBA Name (if different)

EIN / Federal Tax ID (if applicable)

Dunn & Bradstreet # (if applicable)

Date Business Established

State of Incorporation (if applicable)

Business Entity Type

Corporation Sole Proprietorship Partnership LLC Individual (no business entity)

Small Business Classification (check all that apply)

Small Business Small Disadvantaged Business Veteran Owned Small Business HubZone Small Business Woman-Owned Small Business Service-Disabled Veteran Owned Large Business Concern SBA Certified

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

8

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

How do you prefer to communicate with dispatch? *

Phone Call Text / SMS Courier App (e.g. Onfleet, Circuit) Email Two-Way Radio Any method — flexible

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

10

Required Documents & Vehicle Photos

All documents marked Required must be uploaded before your application can be reviewed. Photos must be clear and taken on the day of application.

Insurance Documents *

🚗

Auto Insurance — Proof of Coverage

Declarations page showing policy number, carrier, coverage amounts, and expiration date. Minimum 100/300/100.

Required

Vehicle Registration *

📋

Vehicle Registration — Current

Must show vehicle make, model, year, VIN, and current registration year. Must not be expired.

Required

Certification Documents — Upload copies for each cert you hold

HIPAA Privacy & Security

No file uploaded

DOT Hazardous Materials

No file uploaded

USP <800> / Chemotherapy Transport

No file uploaded

Bloodborne Pathogens (OSHA)

No file uploaded

TSA PreCheck / TWIC / IAC

No file uploaded

Any Other Certification

No file uploaded

Only upload certifications you currently hold. You will not be penalized for missing certs — we offer training through our partner Supremus Group.

Vehicle Photos — 5 Required *

Photos must be taken on the day of application. Vehicle must be clean and clearly visible. All 5 angles are required before submission.

🚗

Front

Full front view of vehicle

Required

🔙

Rear

Full rear view of vehicle

Required

⬅️

Driver Side

Full driver-side profile

Required

➡️

Passenger Side

Full passenger-side profile

Required

🔢

License Plate — Close-Up

Clear, readable photo of license plate with all characters visible

Required

0 of 5 photos uploaded

11

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

DOT / Regulatory Credentials

Independent Contractor / 1099 Information

Professional References

Additional Information

Required Documents & Vehicle Photos

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

DOT / Regulatory Credentials

Independent Contractor / 1099 Information

Professional References

Additional Information

Required Documents & Vehicle Photos

Agreements & Certification

Requirements Checklist

Questions?

Application Received!

Drive With Milagro
Medical Logistics