Online Application

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General Information

Career of Interest: Truck Driver Training Diesel Technician Training

Today's
Date:

First
Name:

Middle
Name:

Last
Name:

Date of
Birth:

Home
Phone:

Cell
Phone:

Emergency
Phone:

Email
Address:

Ht:

Wt:

Current Address

Street:

City:

State:

Zip:

Previous Address

Street:

City:

State:

Zip:

How did you first find out about TDDS?

Education Information

Do you have a: H.S. Diploma GED Neither

What year did you receive it?

State:

Highest Grade Completed:

College: 1 2 3 4

Last Date Attended:

Name and address of high school:

What schools have you attended since high school?

Have you EVER had a student loan? Yes No

If so, are you making payments or are you in loan default? Explain:

Military Information

Branch
Served:

Active Reserves

Type of
Discharge:

If discharge was other than honorable, please explain:

Can you provide a copy of your DD214, Member 4 (Long Form)? Yes No

Dates Served

From:

To:

Criminal Background Information

PLEASE NOTE: A yes answer will not automatically disqualify applicant.

Have you EVER been convicted of a felony? Yes No

Explain:

Have you EVER been convicted of a misdemeanor? Yes No

Explain:

Do you have ANY charges pending? Yes No

Explain:

Employment Information

Current/Last Employer's Name:

Employed
From:

To:

City:

State:

Reason for Leaving:

Second to Last Employer's Name:

Employed
From:

To:

City:

State:

Reason for Leaving:

Third to Last Employer's Name:

Employed
From:

To:

City:

State:

Reason for Leaving:

I understand by completing this application, TDDS Technical Institute is under no obligation to accept me, nor am I under any obligation to TDDS Technical Institute. I hereby authorize TDDS Technical Insitute to research my employment, educational, credit, medical, military, driving history and maintain a permanent student record, the contents of which may be made available at the discretion of TDDS Technical Institute to prospective employers or governmental agencies. It is also agreed and understood that the answers to the foregoing questions have been supplied by me and are true and correct to the best of my knowledge, and that any misrepresentation of information given above shall be considered an act of dishonesty.

Applicant Signature

Online Application

General Information

Personal Information

Driver's License Information

Education Information

Military Information

Criminal Background Information

Personal Health Information

Employment Information