Application for Enrollment

Please fill out form completely. Most entries are required. Your application may be rejected, if not filled out completely.

First Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Home Phone :: Digits only in this format 8885552222

Mobile Phone

Mobile Phone :: Digits only in this format 8885552222

Email Address

Date of Birth

Date of Birth :: Please include / between numbers as in 01/01/80

Drivers License #

Drivers License State

Please answer Yes or No to the following questions:

Are you currently employed?

Yes
No

Where you recently laid off?

Yes
No

Are you a US Veteran?

Yes
No

Will you be funded through an employer or agency

Yes
No

Are you a US Citizen?

Yes
No

Will you need financial aid assistance?

Yes
No

Do you have a high school diploma or GED?

Yes
No

Please answer Yes or No to the following questions. If you answer Yes to any of the below questions, please give an explanation:

Have you ever been convicted of a felony?

Yes
No

If yes, please give an explanation:

Is your vision worse than 20/40 with prescription lenses?

Yes
No

If yes, please give an explanation:

Are you diabetic or on insulin?

Yes
No

If yes, please give an explanation:

Are you deaf in both ears?

Yes
No

If yes, please give an explanation:

Have you had a seizure in the last 5 years?

Yes
No

If yes, please give an explanation:

Have you had any moving violations, DUI, DWI or at fault traffic accidents in the last 3 years?

Yes
No

If yes, please give an explanation:

How did you hear about us?

Please specify:

Which recruiter have you been working with?

By selecting the SUBMIT button below, I acknowledge and understand a YES answer to any of the above questions may prohibit me from obtaining employment as a truck driver or equipment operator. I understand I have submitted this information as being true and accurate; realizing that approval or disapproval of my enrollment will be based on this application and that any misrepresentation or omission of information called for is cause for rejection. Further, I clearly understand that acceptance of my enrollment will be based on this application and the information contained herein. In addition, I hereby authorize the Class A CDL Academy: to investigate the information submitted on this application, to contact individuals or employers listed on this application, to contact state motor vehicle offices in regard to my driving record, to contact governmental agencies related to this application, to request credit information on myself, or to contact any other parties listed on or related to this application. I will not hold Class A CDL Academy or its employees responsible for an adverse or negative action which may result due to my submission of this application. The information provided in this application will not be provided, shared or sold to an outside party.

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Enrollment Info

Class A CDL Academy
a division of The Safety Consortium
400 West Lawndale Dr
Salt Lake City, UT 84115
Phone: 801-637-3813

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