Availability (Select the item that best describes your availability.) 24/7 FLEXIBLE 9(AM)- 6(PM) 3(PM) - 3(AM) 6(AM) - 9(AM) 12(NOON) - 3(PM) 6(PM) - 9(PM) 6(AM) - 12(NOON) 12(NOON) - 6(PM) 6(PM) - 12(MID) 6(AM) - 3(PM) 12(NOON) - 9(PM) 6(PM) - 6(AM) 6(AM) - 6(PM) 12(NOON) - 12(MID) 9(PM) - 12(MID) 9(AM) - 12(NOON) 3(PM) - 6(PM) 9(PM) - 6(AM) 9(AM) - 3(PM) 3(PM) - 9(PM) 9(PM) - 9(AM) 9(AM) - 9(PM) 3(PM) - 12(MID) 12(MID) - 6(AM) Are you ever available to work on Saturdays? Select Yes No Sometimes Are you ever available to work on Sundays? Select Yes No Sometimes Are you ever available to work on Holidays? Select Yes No Sometimes Please use the space below to provide any additional information.

Work Information & Prior Experience Do you have prior experience? Select Yes No Have you EVER been convicted of a felony? Select Yes No Would you be willing to undergo a drug screening? (Some of our customers require this) Select Yes No Is driving in the snow EVER a problem? (We frequently deliver life-saving blood products, medicines, and organs for transplant, year-round) Select Yes No Do you have a GPS Navigation System? Select Yes No Interested in on-call / expedited work? Select Yes No Interested in routes / scheduled work? Select Yes No How soon can you start? Select Right away In a week In two weeks After 2 Weeks