Great Southern Driving Academy, LLC
 
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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