CDL Training Application: Step 2

Your Name *

Telephone *

Cellphone

Email *

Date of Birth *

Social Security # *

Street Address *

Apartment, suite, etc

City *

State *

Zip *

Which Class Are You Applying For? *

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 *

Class *

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 *

Current Employer *

Employed From *

To *

Position *

Previous Employer #1

Employed From

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

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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 *

APPLICATION FOR CDL/HEAVY TRUCK ENROLLMENT

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