Name:           

Address:        

City:              Postal Code:      

Phone Number:        

Have you had any experience delivering newspapers: Yes No

If yes, which Newspapers: 

Current Work Status: Full Time  Part Time  Not Working

If you are working, what time do you start work:

Make and Year of your Vehicle:        

Do You have access to a second vehicle?  Yes  No

Do you have someone you can help you with your deliveries if you are sick or away?  Yes  No