Contractor Application

Complete the form below to apply as an independent medical courier contractor with Clensmedix.

person Applicant Information

Full Name

Phone Number

schedule Availability

Hours Available

Preferred Service Area(s)

work_history Experience

Do you have previous courier or delivery experience?

Yes No

If Yes, Please Describe

Do you have experience handling medical specimens or sensitive deliveries?

Yes No

If Yes, Please Explain

smartphone Technology & Communication

Do you own a smartphone with GPS capability?

Yes No

Are you comfortable using delivery and routing apps?

Yes No

contact_emergency Emergency Contact

Emergency Contact Name

Relationship

Phone Number

gavel Independent Contractor Acknowledgment

I understand that if selected, I will operate as an independent contractor and not as an employee of Clensmedix. I understand that I am responsible for maintaining a valid driver's license, vehicle registration, and automobile insurance at all times.

I acknowledge and agree to the independent contractor terms stated above. I certify that the information provided in this application is true and complete to the best of my knowledge.

Applicant Signature

Date

upload_file Required Documents

Accepted formats: PDF, JPG, or PNG (max 5 MB per file).

Valid Driver's License *

Vehicle Registration *

Proof of Auto Insurance *

Vehicle Photos (Front, Side, and Interior) *

Upload up to 5 photos showing the front, side, and interior of your vehicle.

Resume (Optional)

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Redefining medical logistics with a focus on precision, speed, and safety for the healthcare industry of Texas.