Independent Contractor Application

NOTE: This form is intended for use in evaluating your qualifications to be engaged as an independent contractor. This is not a contract. Please answer all appropriate question completely and accurately. False or misleading statements during the Interview and on this form are grounds for terminating the evaluation process or if discovered after completion, terminating your independent contractor status. Although exlsting federal and state law may not require it, Quick Courier’s policy is that all qualified contractors will recelve consideration without discrimination because of sex, martial status, race, color, age, creed, national origin, sexual orientations, military reserve membership, ancestry, religion, height, weight, deafness or physical handlcap or the presence of disabilities. You may be contracted to other companies during your engagement with Quick Courier and can choose to work for Quick Courier as much or as little as you deem appropriate. In compliance with governmental and insurance regulations, your engagement as an independent contractor will be subject to your successful completion of testing for illegal drugs and a background check.

Since we will make every effort to contact your references, the correct telephone numbers are critical.
FOR REFERENCES OUTSIDE THE U.S., A CUARENT FAX NUMBER IS MANDATORY.

I certify that I have read and understand the note on page one of this form and the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentation of facts, whether on this document or not, may result in rejection of my request to be engaged as an independent contractor or the ending of my engagement by Quick Courier after that engagement has begun. I authorize the company and/or Its agents, including consumer reporting bureaus, to verify and of this Information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any self persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for Issuing this Information. I also understand that the use of illegal drugs is prohibited during my term as an independent contractor. I understand because of governmental and Insurance regulations, Quick Courier may require me to submit to drug testing to deduce the use of illegal drugs prior to and during my independent contractor term.

Although recent court decisions have held that independent contractors are not protected by the Fair Credit Reporting Act (“FRCA”) to the same extent as an employee or an applicant for employment, Quick Courier has determined that the evaluation of your Independent status will include all the FRCA protections. Therefore, I understand and authorize an investigative consumer report to be requested that will include information as to my character, work habits, performance and experience, along with reasons for termination of past employment or engagement as an Independent contractor for other companies. I understand that as directed by governmental and Insurance regulations, Quick Courier may be requesting information from public and private sources about my driving records, court record, Education, credentials, credit, and references.

According to the FCRA, I am entitled to know if my engagement as an Independent contractor is denied because of Information obtained from a consumer-reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original.

I hereby authorize, without reservation, any law enforcement agency, Institution, Information service bureau, school, employer, reference, or Insurance company contacted by Quick Courier or its agent, to furnish the Information described In Section 1. The following information is required by law enforcement agencies and other entities for positive Identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release Quick Courier Services, Inc. and agents and all persons, agencies and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.

Regarding Procurement of a Consumer Report
In Connection with your request to be an independent contractor, we may procure a consumer report on you as part of the process of considering your status as an independent contractor. In the event that information from the report is utilized In whole or in part in making adverse decisions with regard to your potential independent contractor status, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the law.
Please be advised that we may also obtain an investigative report Including Information as to your character, general reputation, personal characteristics, and mode of living. This information may be obtained by contacting companies to which you are presently or to which you were previously engaged as an independent contractor and your previous employers or references supplied by you. Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the Information requested. Such disclosure will be made to you within 5 days of the date on which we received the request from you or within 5 days of the time the report was first requested.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies, You will be given a summary of these rights together with this document.

By your signature below, you hereby authorize us to obtain a consumer report and/or an investigative report about you in order to consider you for independent contractor status.

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learn more or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.

You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

A person has taken adverse action against you because of information in your credit report; you are the victim of identity theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud, you are on public assistance; you are unemployed but expect to apply for employment within 60 days.

In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnizore for additional information.

You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerlinance.com you learn more for an explanation of dispute procedures.

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.govcarimore.com

You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address form the lists these offers are based on. You may opt out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).

The following FCRA right applies with respect to nationwide consumer reporting agencies:

CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE

You have a right to place a “security freeze” on your credit report, which will prohibit a consumer reporting agency from releasing information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans, and services from being approved in your name without your consent. However, you should be aware that using a security freeze to take control over who gets access to the personal and financial information in your credit report may delay, interfere with, or prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, or any other account involving the extension of credit.

As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer’s credit file. Upon seeing a fraud alert display on a consumer’s credit file, a business is required to take steps to verify the consumer’s identity before extending new credit. If you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years.

A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line increases, and account upgrades and enhancements.

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact: