American Driving Academy Courses

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Name (required)

Phone (required)

Alt Name (required)

Address (required)

Email (required)

Driver's License # (optional)

Driver's License Expiration Date

State Issued

Are you over 25 years old?
YesNo


Availability

Hours Available

Total hours available per week

Are you legally able to be employed in the U.S.?
YesNo

School Most Recently Attended

Name

Location

Phone

Last Grade Completed

Grade Point Average

Graduated?
YesNo

Now Enrolled?
YesNo


Two Most Recent Employers

Company 1

Company

Address

Phone

Title

Duties

Supervisor

Dates Worked
to

Salary

Reason for Leaving

Company 2

Company

Address

Phone

Title

Duties

Supervisor

Dates Worked
to

Salary

Reason for Leaving


2 Personal References

Reference 1

Name

Telephone

Address

Relationship to you

Reference 2

Name

Telephone

Address

Relationship to you


Have you ever been convicted of a felony?
YesNo

If yes, please explain (Be sure to include dates and locations)

Have you had any traffic tickets (moving violations) in the last 3 years?
YesNo

If yes, please explain (Be sure to include dates and locations)

Have you ever had your license suspended?
YesNo

If yes, please explain (Be sure to include dates and locations)

Revoked?
YesNo

If yes, please explain (Be sure to include dates and locations)

Ever been arrested for DUI?
YesNo

If yes, please explain (Be sure to include dates and locations)


Emergency Contact Data

In case of an emergency, contact:

Name

Address

Relationship to you

Phone

Alt Phone


I assert that the information contained in this application is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for dismissal in accordance with the policy of this Corporation.

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