Step 1 of 2: Admission Registration
Atlanta CDL Training School
Student Name *
*
First Name
Middle Initial
Last Name
Email Address *
*
example@example.com
Cell Phone *
*
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Date of Birth *
*
-
Month
-
Day
Year
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Last 4 of SSN *
*
Gender *
*
Male
Female
Are you a Company-Sponsored Candidate? *
*
Yes
No
If yes, please list the company:
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Date you are available to start: *
*
-
Month
-
Day
Year
Date Picker Icon
Current Address *
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Driving History
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *
*
Yes
No
Have you ever had your license, permit, or driving privilege suspended or revoked? *
*
Yes
No
Please explain if any of the answer for the above two question is yes.
Are you a citizen of the United States or Permanent Resident? *
*
Yes
No
Have you ever been convicted of a felony? *
*
Yes
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If no, are you permitted to work in the USA and/or have Work Visa? *
*
Yes
No
If yes, explain:
Education
High School Name *
*
High School Address *
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attended From Date *
*
-
Month
-
Day
Year
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Attended To Date *
*
-
Month
-
Day
Year
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*
Did you graduate? *
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Diploma
*
Yes
No
College Name
College Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attended From Date
-
Month
-
Day
Year
Date Picker Icon
Attended To Date
-
Month
-
Day
Year
Date Picker Icon
Did you graduate?
Yes
No
College Degree
Other Education
Other Address
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attended From Date
-
Month
-
Day
Year
Date Picker Icon
Attended To Date
-
Month
-
Day
Year
Date Picker Icon
Did you graduate?
Yes
No
Degree / Certification
Military Service
Branch
From Date
-
Month
-
Day
Year
Date Picker Icon
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To Date
-
Month
-
Day
Year
Date Picker Icon
Rank at Discharge
Type of Discharge
If other than honorable, explain:
Emergency Contact
Contact Name *
*
First Name
Last Name
Relationship *
*
Cell Number *
*
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Address *
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Acknowledgement
Terms of Service *
Applicant Affirmation Under Penalty of Law: I do hereby swear or affirm that all the information that I have provided herein is complete and accurate. I understand that this information will be used only for the purpose of processing my application. I understand that to knowingly make a false statement or conceal a material fact in this application will result in the denial of my application, the cancellation of my certification (if applicable), and criminal charges being brought against me. (Link to terms and conditions will be inserted here once site is live again.)
I have read and understood the terms and conditions.
*
Yes
No
To submit your completed application, click the "Submit Application" Below. You will then be prompted to Review & Sign the application prior to submission and be redirected to Step 2: HIPAA Authorization.
You will receive and email detailing further instructions.
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