EmailMe Form - deliverLA Application

Today's Date *

MM / DD / YYYY

Position applying for? *

Type of employment? *

Full Time

Part Time

Temp Position

What date are you available to start work? *

MM / DD / YYYY

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

Social Security # *

Emergency Contact Name *

First Last

Emergency Contact Phone Number *

### - ### - ####

Relationship to you? *

Your vehicle, driver license & insurance information

Vehicle Type *

Year Make and Model of your vehicle? *

Tell us year, make and model of your vehicle. For example: 2019 Toyota Prius

Current Mileage: *

Vehicle insured by: *

Hybrid? *

Yes

No

Policy number *

Tell us about yourself:

How long have you lived in Los Angeles? *

Have you ever driven for Uber, Lyft, Postmates, etc.? *

Yes

No

Have you worked for courier company before? *

Yes

No

Do you have any moving violations in the past 3 years? *

Yes

No

Do you have any accidents in the past 3 years? *

Yes

No

Any DUI Violations in the past 7 years? *

Yes

No

Any previous work related injuries? *

Yes

No

Do you have any health conditions that prevent you from lifting items? *

Yes

No

Do you smoke in your vehicle? *

Yes

No

Do you agree to random drug testing? *

Yes

No

Please upload a photo of your drivers license *

Please upload your your current insurance *

Please upload your current vehicle registration *

DMV Driver's Record *

Additionally, we require all new drivers to submit a copy of their current DMV Driver Record. You can follow the link above to request a print out. Please upload below:

Please upload your DMV Driver's Record *

Please upload your Resume

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Initial *

Date *

MM / DD / YYYY