Form

Service Contractor Registration Form

Thank you for your interest in joining our network of service providers.

Whether you’re new to the field or already a seasoned professional, this all-in-one form helps us understand your background, availability, and goals.

Please provide as much detail as you can about your experience and training so we can match you with the opportunities that best fit your skill set.

Your Contact Information

Email*

First Name*

Last Name*

Mobile phone number*

LinkedIn URL

Your Location
Note: We are only accepting applications for work in the U.S.

Street address*

City*

State*

Zip Code*

Do you have any interest in opportunities that require travel?*

Yes

Your Abilities, Experience & Education

Which of the following technical activities are you comfortable performing? (Check all that apply)*

Basic Tasks: Handling light equipment, moving items between areas, basic equipment setup.

Simple Assembly/Disassembly: Using common hand tools to assemble or remove basic mechanical components.

Routine Maintenance: Following step‑by‑step instructions (e.g., oiling, cleaning, replacing small parts).

Basic Troubleshooting: Identifying common mechanical or electrical issues using simple testing methods and manuals.

Component Replacement: Removing and replacing larger or more complex parts (motors, circuit boards, etc.).

Calibrations or Advanced Repairs: Using specialized tools or procedures to adjust, align, or repair equipment to manufacturer specifications.

Complex Installations/Deinstallations – Removing and installing large or more complex equipment (e.g., surgical lights) with attention to safe handling, proper alignment, and any required testing.

Specialty Trades: Welding, soldering, small engine repair, HVAC, or other trade‑specific skills.

Other

Outline your work history. *

Do you have work experience maintaining, servicing, installing, or testing medical equipment?*

Yes

Check all education programs you have completed:*

Please provide the names and contact information here for any references you would like to add.

If you have one, feel free to provide a resume

Your Availability

When are you generally available to work?*

Days

Evenings

Overnight

Weekends

How many hours per week on average would you be open to taking on contract work?*

Your Interest & Motivation

How did you hear about us?

Please indicate your level of comfort engaging in physically demanding tasks, such as moving or lifting equipment and working on your feet for extended periods.*

I thrive in a very active role. I’m comfortable with frequent walking and tasks that require physical stamina.

I’m fine with some lifting and standing, but I prefer a balance that includes lighter tasks alongside moderate physical work.

I’m more comfortable in roles with minimal lifting or physical exertion, focusing on tasks that are less physically demanding.

Your Questions or Comments

Any final questions or comments?

Once you submit this form, our team will review your information and follow up with any next steps—such as an interview invitation or additional details about our program. We appreciate the time you’ve taken to share your experience and look forward to exploring how we can work together.

Have immediate questions? Email us at service@medservmarketplace.com.

Thank you for joining us on our journey. 😊