Student Interview

Date:

Name*:

Address*

Phone*:

Email Address*:

Birth Date*:

IT IS IMPORTANT THAT ALL QUESTIONS BE ANSWERED COMPLETELY

Driver's License Number:

SSN:

High School Diploma?

GED?

Have you attended college?

Are you currently working?

Are you collecting unemployment benefits?

How will your schooling be paid for?

Have you served in the Armed Forces?

How did you hear about Check Ride?

Can you meet the following requirements in order to receive a CDL Learner's Permit?

Do you currently hold a valid Washington Driver’s License?

Can you provide your social security number?

Can you pass a DOT physical examination?

Can you operate a 'stick shift' - car, etc. having a clutch?

Can you back any kind of trailer (boat, motorcycle, car, etc.)?

What types of trucking industry jobs do you believe you want?

DIRECTIONS: Please answer the following YES and NO questions. If "No," please move onto the next question. IF "Yes," please explain in the box below the question.

Is there anything on your driving record in the past five (5) years?

Is your driver's license currently expired, suspended, or invalid?

Have you been convicted of more than three (3) moving violations in the last three (3) years?

Have you ever been convicted of an alcohol or drug related traffic violation?

Is your license currently or has it ever been suspended or revoked in Washington or any other state?

Do you have any medical, physical or learning disability problems that could hinder your truck driver training?

Do you have any medical problems & are you on any prescribed medications?

Do you currently have any outstanding or unpaid traffic fines?

Have you ever been convicted of a felony or misdemeanor?

Have you ever failed a DOT or Random Drug Test?

Have you ever taken illegal drugs?

Work history for the last THREE years. THIS IS REQUIRED INFO BY THE DOT.

Name of Employer

Dates Employed

Supervisor

Phone # (area code)

Address

Job Responsibilities

Reason for Leaving

Eligible for rehire?