National Tractor Trailer School

NTTS Student Application

Applicant must complete this application. Fields designated with an asterisk (*) are required.

Student Application

The applicant must complete this application - all items marked with an asterisk must be completed.

Name*
First Middle Last
Email*
Address*
Street Address City State ZIP Code
Sex*
Age*
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Home Phone*
Cell Phone
Alternate Phone
Marital Status*
Veteran*
Dates of Service
Emergency Contact Name*
Emergency Contact Phone*
Emergency Contact Relationship*
Driver's License Number (no dashes)*
State*
License Type*
License Expiration Date*
MM slash DD slash YYYY
Do you have any moving violations/speeding tickets in the last 3 years?*
Has your license been suspended or revoked in the last 5 years?*
Were you convicted of careless/reckless driving or following too close in the last 5 years?*
Were you convicted of D.W.I.(s) or D.U.I.(s) in the last 10 years?*
Have you had more than one preventable motor vehicle accident in the last 5 years?*
Do you have any felony or misdemeanor convictions?*
Explain any YES answer
MEDICAL (must be DOT qualified)
Do you have eyesight that is 20/40 or better (corrected)?*
Do you have any hearing loss?*
Do you have high blood pressure?*
Do you have heart troubles?*
Do you have color blindness?*
Do you have epilepsy?*
Do you have diabetes?*
Do you have any sleeping disorder, pauses in breathing while asleep, daytime sleepiness or loud snoring?*
Have you ever had a sleep test?*
If you are currently taking medications, please list which kinds.
Education completed*
Are you a US Citizen?*
If no, are you an eligible non-citizen?
Race (Optional)
EMPLOYMENT
Current Employer*
Dates of Employment (Ex: 2016 - 2019)*
Employer Address
Street Address City State ZIP Code
Employer Phone
Position
Annual Salary
Past Employer
Employer Address
Street Address City State ZIP Code
Employer Phone
Position
Annual Salary
Reason for leaving
Why are you considering changing careers?
Are you disatisfied with your current employer? If yes, why?
What most appeals to you about a career in trucking?
How long have you considered a career in truck driving?
By submitting this form, you hearby certify that the information presented on this form is factual to the best of your knowledge. You also certify that you are drug free. By submitting this form you also authorize NTTS to perform a background check on yourself, including a credit history check. You also release NTTS and any persons affiliated with NTTS from all liability relating to the gathering or furnishing of information.
FOR OFFICE USE ONLY: (rate items below good, fair or poor)
Work History: ____________ Driving/Police Record ____________ Attitude: ____________ Evaluation by: _____________________________________ Comments:______________________________________________________________________________________________________________________ Interviewer: Do you recommend this applicant? Yes: ________ No: ________ If no, explain why: _____________________________________________ Class date: ______________ Housing: ______________ CHOOSE (circle one): FT PT B 7 10 18 24 Other: _________________ $ _________________ Date Evaluated: ___________________ Interviewer's Signature: _________________________________________