Great Southern Driving Academy- Truck Driving School. Tunnel Hill, GA.

Great Southern Driving Academy, LLC

Application

Name:
(required)

DOB:

Phone:

E-mail:
(required)

Address:

City:

State:

Zip:

Driver's License Number State Issued Expiration Date

Social Security #

Driving History
Have you ever had your driver's license revoked?

Yes:

No:

If yes, give the year and reason:

In the last 5 years, how many tickets have you received?

Ticket #1 Year and reason:

Ticket #2 Year and reason:

Ticket #3 Year and reason:

In the last 5 years, how many accidents have you had?

Have you ever been convicted for a DUI?

Yes:

No:

Year:

Have you ever been convicted of a felony or misdemeanor?

Yes:

No:

Year:

If yes, give the year and reason:

If yes, please explain:

The essential funchtion of a road driver is:

Must be available for work 24 hours per day, 7 days per week, working 70 hours in 8 days (drive a continuous 10 hours, or as Section 395 allows).

Be able to load or unload cargo up to 75 pounds per item.

Be able to: dolling trailer, sliding tandems, pulling king pin and hood for pre-trip inspections and fueling the truck.

Can you perform the job functions just described?

Yes:

No:

Current medications:

Have you ever filed a workers' comp claim?

Yes:

No:

Year:

If yes, please explain:

Employment

Current/Last Employer:

Dates of Employment: From

To:

Complete address:

Phone:

Job Title:

Reason for leaving:

Previous Employer:

Dates of Employment: From

To:

Complete address:

Phone:

Job Title:

Reason for leaving:

Previous Employer:

Dates of Employment: From

To:

Complete address:

Phone:

Job Title:

Reason for leaving:

By clicking submit, I certify that to the best of my knowledge the above information is true.

Great Southern Driving Academy, LLC

P.O Box 99
Tunnel Hill, GA 30755-9325

Education Director: Bryan Riddle

Phone: (706) 673-1992

Fax: (706) 673-6876

Toll Free: (866) 319-1992

Admissions Director: Catherine Riddle