CDL College Online Enrollment Application

First Name:* Last Name:*

Age:* Email Address:*

Contact Phone:* Cell Phone:

City:* Zip Code:*

Us Citizen?: YesNo Need Financial Assistance? YesNo

Enrollment Questions

Is your driver's license current and valid? .................................................................................................................................. YesNo

Have you had more than three traffic violations within the last 3 years? .................................................................................. YesNo

Have you been involved in any at-fault accidents within the last 3 years? ............................................................................... YesNo

Are you eligible to work in the United States? ............................................................................................................................ YesNo

Have you ever been convicted of, or are charges currently pending for any of the following:

Felony: ......................................................................................................................................................................................... YesNo

Misdemeanor: .............................................................................................................................................................................. YesNo

Driving a vehicle while under the influence of alcohol (.04 or more) or controlled substances.................................................. YesNo

Careless or reckless driving ....................................................................................................................................................... YesNo

Has your license ever been suspended? ................................................................................................................................... YesNo

Posession, sale or use of controlled substance including marijuana ......................................................................................... YesNo

Leaving the scene of an accident .............................................................................................................................................. YesNo

Have you ever violated any DOT prohibitions on drug or alcohol use? (refused to take a test, used drugs/alcohol during or before work, worked while impaired by alcohol or drugs) ......................................................................................... YesNo

Have you ever tested positive or refused to test on any pre-employment drug or alcohol test given by an employer or contracting company to which you applied for, but did not obtain, work? ............................................................................ YesNo

Have you ever been told you tested positive for drugs or alcohol? .......................................................................................... YesNo

Please use the box below for any notes or explanations.