Automotive CTI sign up form
This form is for all those applying to the Automotive Night school course at South Shore Votech!
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Referred by High School
Yes
No
Referring High School
Referring School Administrator
How did you hear?
*
Are you 17 – 24 years of age? If yes, you may be eligible for additional services, incentives and benefits.
*
Yes
No
Valid Drivers License
*
Yes
No
License Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Currently Employed?
*
Yes
No
Employer Name
Current Salary in USD
*
Does this training relate to your current job/background?
*
Yes
No
Explain how?
*
Trade Licenses
*
Have you taken any other CTI training program in the past?
*
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