TRUCK DRIVING (CDL) APPLICATION

Applicant History
Were you referred to school by someone? *
If yes, then who?*

First NameLast Name
Do you have any friends or relatives that work for Top Gun Truck Driving Academy or Kiamichi Tech?*
If yes, then who?*

First NameLast Name
Have you applied to the CDL program previously?*
If yes, when?*

MonthDayYear
Date
Are you 18 years old?*
How will you get to class? *
Are you looking for night and weekend classes?*
If yes, please state any limitations:*
If you are accepted into the ELDT course, when would you be available to begin?*

MonthDayYear
Date
If accepted are you able to submit proof that you are legally eligible for employment in the United States?*
Can you carry out the core duties of the student role you areapplying for without needing reasonable accommodations?*
If no, What reasonable accommodations, if any, would you request?*

Education*

Please indicate any current professional licenses or certifications that you hold (type N/A if there are none):*
Awards, Honors, Special Achievements (type N/A if there are none):*
Military Service:*
Branch:*
Specialized Training:*

Employment History

List your most recent employment. Please list all jobs (including self-employment and militaryservice) which you have held, beginning with the most recent, and list and explain any gaps inemployment. If additional space is needed, continue on the back page of this application.
Employer Name*
Supervisor Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Job Duties:*
Reason for Leaving:*
Start Date:*

MonthDayYear
Date
Do you currently work there? *
End Date:*

MonthDayYear
Date
Employer Name
Supervisor Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Job Duties:
Reason for Leaving:
Start Date:

MonthDayYear
Date
Do you currently work there?
End Date:

MonthDayYear
Date
Employer Name
Supervisor Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Job Duties:
Reason for Leaving:
Start Date:

MonthDayYear
Date
Do you currently work there?
End Date:

MonthDayYear
Date
Employment Gaps Explanation (type N/A if there are none): *
Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer (type N/A if there are none):*

References

List any two non-relatives who would be willing to provide a reference for you.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship*

Certification
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application.

I authorize Top Gun Truck Driving Academy and Kiamichi Tech to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.*

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Applicant Information