CDL Training Application: Step 2

Application for CDL/Heavy Truck Enrollment

• Full Name *
  

• Telephone *
  

• Cellphone
  

• Email *
  

• Date of Birth *
  

• Social Security # *
  

• Street Address *
  

• City *
  

• State *
  —Please choose an option—Alabama - ALAlaska - AKArizona - AZArkansas - ARCalifornia - CAColorado - COConnecticut - CTDelaware - DEFlorida - FLGeorgia - GAHawaii - HIIdaho - IDIllinois - ILIndiana - INIowa - IAKansas - KSKentucky - KYLouisiana - LAMaine - MEMaryland - MDMassachusetts - MAMichigan - MIMinnesota - MNMississippi - MSMissouri - MOMontana - MTNebraska - NENevada - NVNew Hampshire - NHNew Jersey - NJNew Mexico - NMNew York - NYNorth Carolina - NCNorth Dakota - NDOhio - OHOklahoma - OKOregon - ORPennsylvania - PARhode Island - RISouth Carolina - SCSouth Dakota - SDTennessee - TNTexas - TXUtah - UTVermont - VTVirginia - VAWashington - WAWest Virginia - WVWisconsin - WIWyoming - WY

• ZIP Code *
  

• Which Class Are You Applying For? *
  AB

• Do you have a job lined up? If so, with whom?
  

• Martial Status *
  MarriedSingleDivorcedSeperated

• Number of Dependants *
  

• Emergency Contact Name*
  

• Telephone *
  

• Relationship *
  

• Drivers License # *
  

• State *
  —Please choose an option—Alabama - ALAlaska - AKArizona - AZArkansas - ARCalifornia - CAColorado - COConnecticut - CTDelaware - DEFlorida - FLGeorgia - GAHawaii - HIIdaho - IDIllinois - ILIndiana - INIowa - IAKansas - KSKentucky - KYLouisiana - LAMaine - MEMaryland - MDMassachusetts - MAMichigan - MIMinnesota - MNMississippi - MSMissouri - MOMontana - MTNebraska - NENevada - NVNew Hampshire - NHNew Jersey - NJNew Mexico - NMNew York - NYNorth Carolina - NCNorth Dakota - NDOhio - OHOklahoma - OKOregon - ORPennsylvania - PARhode Island - RISouth Carolina - SCSouth Dakota - SDTennessee - TNTexas - TXUtah - UTVermont - VTVirginia - VAWashington - WAWest Virginia - WVWisconsin - WIWyoming - WY

• Class *
  —Please choose an option—ABCDDJEMMJDon't Know

• Expiration Date *
  

• Have your served in the US Military? *
  YesNo

• Highest Level of Education *
  

• What Appeals to You About Trucking?
  

• How Will You Be Paying for Course? *
  

• If Accepted, When Can You Begin? *
  

• Are You Interested In Long, Regional, or Local Haul? *
  LongRegionalLocalDon't Know

• Are You a US Citizen? *
  YesNo

• Resident Alien Date of Arrival
  

• Character Reference #1 *
  

• Relationship *
  

• Telephone *
  

• Character Reference #2 *
  

• Relationship *
  

• Telephone *
  

• Current Employer *
  

• Employed From *
  

• To *
  

• Position *
  

• Previous Employer #1
  

• Employed From
  

• To
  

• Position
  

• Reason for leaving
  

• Previous Employer #2
  

• Employed From
  

• To
  

• Position
  

• Reason for leaving
  

• Previous Employer #3
  

• Employed From
  

• To
  

• Position
  

• Reason for leaving
  

• Any moving violations in the last 5 years? *
  YesNo

• Any accidents in the last 5 years? *
  YesNo

• DWI/DUI/DWAI? *
  YesNo

• Had a license suspended or revoked? *
  YesNo

• Have any felony or misdemeanor convictions? *
  YesNo

• Do you have at least 20/40 vision or better (with corrective lenses)? *
  YesNo

• Do you have any hearing loss? *
  YesNo

• Are you color blind? *
  YesNo

• Do you have heart trouble? *
  YesNo

• Do you have fainting or dizzy spells? *
  YesNo

• Do you have epilepsy? *
  YesNo

• Do you have diabetes? *
  YesNo

• Do you take medication? *
  YesNo

• Thank you for your interest in the Canandaigua Driving School! Please initial below to certify that the information you have provided is factual to the best of your knowledge. You also cetify that you are drug free. You authorize Canandaigua Driving School to perform a background check including a credit history if necessary and release Canandaigua Driving School and any persons providing information from all liability relating to the gathering or furnishing of information.

  Initials *