School Application

Name*
First Last
License Information
State
License No.
Type
Expiration Date
Date Format: MM slash DD slash YYYY
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
Date Format: MM slash DD slash YYYY
Violation
State of Violation
Penalty
Date Convicted
Date Format: MM slash DD slash YYYY
Violation
State of Violation Location
Penalty
Date Convicted
Date Format: MM slash DD slash YYYY
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 Format: MM slash DD slash YYYY
Date To
Date Format: MM slash DD slash YYYY
Street Address
City
State
Zip Code
Contact Person Name
Phone
Your Position
Salary/Wage
Reason for Leaving
Employer 2
Name
Date From
Date Format: MM slash DD slash YYYY
Date To
Date Format: MM slash DD slash YYYY
Street Address
City
State
Zip Code
Contact Person Name
Phone
Your Position
Salary/Wage
Reason for Leaving
Employer 3
Name
Date From
Date Format: MM slash DD slash YYYY
Date To
Date Format: MM slash DD slash YYYY
Street Address
City
State
Zip Code
Contact Person Name
Phone
Your Position
Salary/Wage
Reason for Leaving

License Information