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Date: 

Name:             Drivers License #: 

Street Address: 

City:       State:       Zip Code: 

Date of Birth:       Age: 

Home Phone:       Cell Phone: 

Email Address: 

Marital Status:  Married Single
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Have you visited our school before?  Yes No

How did you learn about our school?  Newspaper Referral Internet Website Class 'A' Website Other

Present Employer:       Hours Worked: 

Do you have truck driving experience?  No Yes      Company:

Type of job desired:  Over the Road Regional Local

When would you like to begin training? 

Could you finance training?  Yes No     How? 
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Military Personnel:

Active in Military:  Yes No

Veteran?  Yes No

Enter Promo Code (optional): 
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The following questions are designed to assist us in helping you obtain employment in the trucking industry. It is very important that you answer these questions honestly and completely. A positive response to any of these questions DOES NOT necessarily disqualify you from employment-- companies will look at each application on an individual basis. We need to understand your circumstances in order to assist you properly through the job placement process.

Have you ever been convicted of a Felony in your lifetime?  Yes No
(If Yes, please explain)


Have you ever been convicted of a Misdemeanor in your lifetime?  Yes No
(If Yes, please explain)


Do you have any Criminal Charges pending?  Yes No
(If Yes, please explain)


Have you ever tested positive on a pre-employment or employment Drug Screen?  Yes No
(If Yes, please explain)


Have you had any Moving Violations in the last three years?  Yes No
(If Yes, please explain)


Have you had any Accidents in the last three years?  Yes No
(If Yes, please explain)


Have you had any License Suspensions?  Yes No
(If Yes, please explain)


Have you ever been convicted of a Careless/Reckless traffic offense in the last five years?  Yes No
(If Yes, please explain)


Have you ever had a DWI, DUI or any other Alcohol Offense in your lifetime?  Yes No
(If Yes, please explain)


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I understand that the information I have provided will be placed in my file and will only be available to authorized persons and perspective employers. I also understand that in completing this qualification sheet, Class 'A' is under no obligation to accept me, nor am I under any obligation to the School. In connection with my application to the School, I understand that a consumer report containing public records may be requested.

By clicking the submit button below, I accept the terms of this form: