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Independent Contractor Questionnaire
First Name
Last Name
Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Email
Phone
You must be at least 18 years old, have a valid driver's license, own or have access daily to reliable transportation, and possess proof of insurance in your name. Do you meet these minimum standards?
Yes
No
Please select what type of vehicle do you primarily drive?
Small Car
Midsize Car
Small SUV or Van
Regular SUV or Van
Large SUV or Van
Small Truck
Midsize Truck
Large Truck
Box Truck
Other
Please select which best describes your primary vehicle?
2-wheel (front)
2-wheel (rear)
4x4
4x4 (automatic)
Do you have access to a secondary vehicle?
Yes
No
Please select the option that most-accurately describes your secondary vehicle?
Small Car
Midsize Car
Small SUV or Van
Regular SUV or Van
Large SUV or Van
Small Truck
Midsize Truck
Large Truck
Box Truck
Other
Please select which best describes your secondary vehicle?
2-wheel (front)
2-wheel (rear)
4x4
4x4 (automatic)
Do you have any experience delivering newspapers?:
Yes
No
Have you ever delivered newspapers for Herald-Dispatch, Charleston Gazette-Mail, or other HD Media newspapers?
Yes
No
What relevant experience or comments would you like to share with our delivery supervisors as we consider your credentials?
Send
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