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Truck Driving School Application

First Name

Last Name

Phone

Email

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Section A

Date of birth

Address

How long at above address?

Previous Address

Last job of 6 months or more (Company)

Company Phone Number

Emergency Contact Information (Name, Relationship, Address, Phone Number)

Section B

Can you read, write, and speak English?

Yes

No

Are you over 21 years of age?

Yes

No

Are you married?

Yes

No

Can you provide a High School Diploma?

Yes

No

Do you have children?

Yes

No

Are you a citizen of the United States?

Yes

No

Do you have a current and valid California Drivers License?

Yes

No

Section C

Have you had any traffic light citations in the past 3 years?

Yes

No

Have you had any accidents in the past 3 years?

Yes

No

Has your Drivers License ever been suspended or revoked?

Yes

No

Have you ever gotten a DWI or DUI?

Yes

No

If you answered yes to the previous question, what was the date you recieved a DWI/DUI?

Have you ever been arrested for any narcotics charges?

Yes

No

Have you ever held a commercial license?

Yes

No

Do you have any felonies or midemeanors?

Yes

No

Do you have any physical or mental disabilities at this time?

Yes

No

Are you currently on any medications?

Yes

No

Do you wear any hearing apparatus?

Yes

No

Do you have any eyesight impairments or colorblindness?

Yes

No

Have you physically lost any part of your body?

Yes

No

Are you presently employed?

Yes

No

Please give an explanation to each question you answered "Yes" to in Section C:

Section D

Is there a reason you cannot verify your past employment history for the past 10 years?

Yes

No

Have you ever been fired from a past employer?

Yes

No

Have you ever been injured on the job or received worker's comp?

Yes

No

Is there a reason you cannot be away from home for extended periods (3-4 weeks)?

Yes

No

Have you ever been on probation or parole?

Yes

No

Please give an explanation to each question you answered "Yes" to in this section:

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Truck Driving School

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Nationally Accredited By COE AND LICENSED BY STATE OF CA BPPE

8530 Commercial Way, Redding, CA 96002, USA

8530 Commercial Way, Redding, CA 96002

Monday–Friday 8:00 AM-5:00 PM

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