Enrollment Application

Name :

Address :

Phone :

Date of Birth :

Driving License # :

What program are you interested in ?

Valid class C license :

Prior commercial license :

Current CDL permit :

Any DUI/DWI within past 10 yrs If yes, how many ? :

Any issues on driving record if yes please explain :

Last company worked for( if self employed please state so)

Any felonies or misdemeanors within the past 10 yrs.( For employment purposes) If yes please explain

Are you taking any medication or have medical or health issues If yes please explain

Which documents do you have for Educational Qualifications?

How did you hear about us?

Are you paying your tuition yourself?

Do you need financial assistance? If yes, give us a call and so we can guide you to an agency that may be able to assist.

If you are working with a funding agency please provide the name of the agency, counselor and contact phone number.

Please provide the names and numbers of 2 persons in the event of an emergency

Name :

Phone :

Relationship :

ADDRESS
25425 Industrial Blvd.
Hayward, CA 94545

CALL US
(510) 925-5289

EMAIL
cdlschoolbayarea@gmail.com