AKA Hauling CDS | Student Registration Form

Student Registration

AKA HAULING COMMERCIAL DRIVING SCHOOL
6131 B STREET • ANCHORAGE, AK 99518 • CONTACT@AKADRIVING.COM
Student Name*

First NameMiddle InitialLast Name
Student E-mail*
example@example.com
Contact Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
Age*
Social Security Number*
Alaska Driver's License #*
Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Select which best describes you:

Individual RegistrationEmployee Registration through an Organization
Organization or Company Name

Documentation

Upload your Alaska Driver's License (front & back) and if applicable any proof of certifications.
Upload Required Documents*

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Applicant Signature
Signature*

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Print Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Should be Empty:

	Yes	No
US Citizen
Legal Resident of Alaska
Veteran
Do you have a current AK driver’s license?
Have you had a driver’s license for over a year?
Do you currently have a DOT Physical? If yes, provide DOT Physical expiration below.
Do you have experience driving any manual type of vehicle over 960 hours (6 months)? If yes, please describe that experience below.
Do you have any experience backing up a trailer over 960 hours (6 months)? If yes, please describe that experience below.

Student Registration