School Application

Name*
First Last
License Information
State
License No.
Type
Expiration Date
Address Information
Street Address
City
State
Zip Code
How long have you lived at this address?
Are you legal to work in the U.S.A. ?
- Yes
- No
Telephone Number*
Email Address*
Are you an honorably discharged veteran of the United States Military?
- Yes
- No

Traffic Convictions and Forfeitures for the past 3 years (other than parking violations)
Date Convicted
Violation
State of Violation
Penalty
Date Convicted
Violation
State of Violation Location
Penalty
Date Convicted
Violation
State of Violation Location
Penalty
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
- Yes
- No
Explain*
Has any license, permit or privilege ever been suspended or revoked?
- Yes
- No
Explain*
Have you ever been convicted of a felony?
- Yes
- No
What and When?*
Have you ever been convicted of a misdemeanor?
- Yes
- No
What and When?*

Employment History
(Please note: Your current employer will NOT be contacted unless you tell us it is alright to do so)
Employer 1
Name
Date From
Date To
Street Address
City
State
Zip Code
Contact Person Name
Phone
Your Position
Salary/Wage
Reason for Leaving
Employer 2
Name
Date From
Date To
Street Address
City
State
Zip Code
Contact Person Name
Phone
Your Position
Salary/Wage
Reason for Leaving
Employer 3
Name
Date From
Date To
Street Address
City
State
Zip Code
Contact Person Name
Phone
Your Position
Salary/Wage
Reason for Leaving

License Information