Yellow Cab of Lancaster 625 East Orange Street Lancaster, Pennsylvania Independent Contractor Application This application is to be completed by an individual requesting to be considered for a position as an independent contractor taxi driver. Personal Information Name:   Social Security No.:   Date of Birth: Address:   City:   State: ALAKARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVIVTWAWIWVWY   Zip Code: Phone No.: Work Information What date would you be able to start as a driver? Would you be able to work full-time days? YesNo   Full-time evenings?   YesNo                                     Week-end days? YesNo   Week-end evenings? YesNo Driver's License No.:   State of License: ALAKARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVIVTWAWIWVWY Do you or anyone you live with have car insurance?  YesNo If yes, complete insurance company name and policy number: Automobile Insurance Company:   Policy No. Applicant's Statement As an applicant to be an independent contractor taxi driver, I certify that answers given herein are true and complete to the best of my knowledge. I understand that if the application is accepted, I will become an independent contractor taxi driver and not an employee of Yellow Cab of Lancaster. Disclosure and Release Form Driving and Personal Record Information In connection with my application to become an independent contractor taxi driver, I hereby give my permission to Yellow Cab of Lancaster to obtain my state driving record (known as my motor vehicle record or MVR). I acknowledge and understand that my driving record is a consumer report that contains public record information. I authorize, without reservation, any party or agency contacted by Yellow Cab of Lancaster to furnish the above-mentioned information and understand that I have the right to request a copy of my driving record and to know the source or sources of my driving record for a two-year period preceding my request. This authorization shall remain on file with Yellow Cab of Lancaster for the duration of our relationship as an independent contractor taxi driver and company to procure my state driving record at any time during this period. I understand that the company may take adverse action affecting our relationship as an independent contractor taxi driver and company based on the information contained in my driving record. If such action is taken, I acknowledge that I have the following rights: The company must notify the independent contractor taxi driver in writing of any such adverse action. I have the right to receive a copy of the driving record upon which the adverse action was based. I have the right to receive a summary of my rights under the Fair Credit Reporting Act. I have the right to know the name, address, and telephone number of the consumer reporting agency that provided my driving record. I have the right to obtain a free copy of my driving record for the agency that provided it, if such a request is made with sixty days from the date that the Company took adverse action and the right to dispute the accuracy or completeness of my driving record with the consumer reporting agency that provided it and request that errors be corrected, if any exist. I also give the right to request a background check that may include a criminal report. I release from all liability all persons, companies, and corporations supplying such information.                                                               By clicking the Submit button, I hereby agree to the terms above:

625 East Orange Street, Lancaster, PA 17602 | 1-800-795-FAST | (717) 392-2222 | FAX (717) 394-6937