Chauffeur Application – Apex Black Car

Applicant Type

I am applying as

Individual / Sole Proprietor — personal name (SSN required) Company / LLC / Corporation — business entity (EIN required)

Individual — Personal Information

Complete this section if applying as an Individual / Sole Proprietor. Company/LLC applicants: skip to Section C.

Full Legal Name

Date of Birth

Social Security Number (SSN)

Home Address

Mobile Phone

Email Address

Company / LLC — Business Information

Complete this section if applying as a Company / LLC / Corporation. Individual applicants: skip to Section D.

Company Legal Name

DBA / Operating Name

Employer Identification Number (EIN)

Entity Type

State of Incorporation / Registration

Business Address

Business Phone

Business Email

Authorized Representative — the person authorized to sign on behalf of the company and who will drive.

Representative Full Legal Name

Title / Role

Representative Date of Birth

Personal Mobile

Personal Email Address

Driver's License & Compliance

Driver's License Number

License Class

Issuing State / Province

License Expiry Date

Violations (past 3 years)

For-Hire / TNC / Livery License #

Livery License Expiry

Background check (CORI) consent?

DMV driving record access authorization?

Commercial Insurance

Commercial / livery auto insurance is required. Personal auto policies do not qualify. Coverage must list passengers for hire.

Insurance Carrier / Provider

Policy Number

Policy Type

Policy Expiry Date

Bodily Injury (per person)

Bodily Injury (per occurrence)

Property Damage

Insurance Agent Name

Agent Phone

Can BCR be added as an additional insured / certificate holder?

Experience & Availability

Years of Professional Driving

Previous Employer / Platform (most recent)

Languages Spoken

Airports You Know Well

General Availability

Engagement Type Preference

Earliest Available Start Date

Emergency Contact

Full Name

Relationship

Phone Number

Application & Declarations

Why do you want to drive for Black Car Rides?

Independent Contractor (1099). I understand I am applying as an independent contractor, not an employee of Apex Black Car. Apex Black Car bears no employer obligations toward me.
Accurate Information. All information in this application is accurate and complete to the best of my knowledge.
Background Check. I consent to a CORI / criminal background check and authorize Apex Black Car to request my DMV driving record.
Sensitive Data. My SSN / EIN is collected solely for IRS 1099-NEC reporting and identity verification. It is stored encrypted and never shared beyond those uses.
Insurance. I confirm I hold (or will obtain prior to onboarding) commercial / livery auto insurance meeting Apex Black Car's minimum coverage requirements.
Vehicle Standards. I agree to maintain my vehicle(s) to BCR's cleanliness, presentation, and mechanical standards at all times while on service.

I have read and agree to all declarations above and confirm all information submitted is truthful and accurate.

Declaration

By checking this box, I agree to receive SMS messages for conversational purposes from Apex Black Car at the phone number provided above. SMS frequency may vary. Message and data rates may apply. Reply STOP to opt out. Reply HELP for assistance. I confirm that I have read and agree to the Privacy Policy and Terms & Conditions.

Chauffeur Application (1099)