GoGoLiberty Employment Application

Position Applying For Select Driver / Transportation Driver Medical Courier Driver GoGoMunch Driver Administrator Call Center Representative Incident / Accident Representative Onboarding Representative Payroll Representative Compliance Support General Worker Desired Work Type Select Employee Independent Contractor Part-Time Full-Time Seasonal / As Needed Full Name Preferred Name Email Phone State Select AL AK AZ AR CA CO CT DE 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 City Address ZIP Code Department Preference Select if applicable Driver Operations Call Center Incident Department Onboarding Department Payroll Department Administration Compliance Are you legally authorized to work in the United States? Select Yes No Are you at least 18 years old? Select Yes No Do you consent to background screening if required? Select Yes No Have you worked with GoGoLiberty before? Select Yes No Vehicle Type Select if applying for driver/courier Car SUV Van Truck Driver License State Select if driver/courier AL AK AZ AR CA CO CT DE 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 Driver License Number Do you have current vehicle insurance? Select if driver/courier Yes No Interested in medical courier work? Select Yes No Experience Skills Current or Most Recent Employer Earliest Start Date Available Start Time Available End Time Available Days

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Availability Notes Why do you want to work with GoGoLiberty? How would you handle an upset customer or caller? If applying for Incident, Payroll, Onboarding, Compliance, or Admin, describe how you handle confidential information. Are you comfortable completing orientation, handbook, NDA, and training? Select Yes No Emergency Contact Name Emergency Contact Phone Emergency Contact Relationship Type Full Name as Signature