America's Driving Force 
                         APPLICATION FOR TRAINING

(I UNDERSTAND THAT IN COMPLETING THIS APPLICATION THE SCHOOL IS UNDER NO
OBLIGATION TO ACCEPT ME, NOR AM I UNDER ANY OBLIGATION TO THIS SCHOOL.)


                                                       Date ________
Social Security # _______________

Name __________________________________Phone # _________________________
     Last            First       Middle
Present Address ______________________________________ How Long? _______
                Street          City      State    Zip
Previous Address  _____________________________________ How Long? ______
                  Street        City      State     Zip
Age ______ Date of Birth ___________


How did you first hear about our school?  Radio ___ Billboard _____ 
JTPA ______  Yellow pages ad _____  Newspaper ad _____ 
Other _____________________


After discussing with your family your interest in learning about the
trucking industry, what was their reaction?  

___ Interested    ___ Cooperative   ___ Not interested


After graduation would you prefer local employment, or if the conditions
were satisfactory, would you be willing to relocate?____________________


Why are you interested in becoming a Professional Tractor-Trailer Driver?
_____________________________________________________________________


How long have you been seriously considering  becoming a Professional 
Driver?  ____________________________________________________________
_____________________________________________________________________


Judging from your observation of the trucking industry, which of the
following types of driving jobs would you be willing to accept?

____ Local        ____ Short Line          _____ Long Distance


Could you accept employment within two (2) weeks after completing the 
training program?      ____ Yes      ____ No

 
HEALTH                                                       

Date of last Physical  ________ Results______________________________
Physical  defects ___ Yes ___ No    If yes, describe  _______________
_____________________________________________________________________
_____________________________________________________________________

Do you have good use of Hands? ____ Arms ? ____ Legs? ____ Feet? ____
Good hearing? ____ Good eyesight? ____ Have you ever been dizzy? ____
Passed out ? ____ Have you ever had back trouble? ____  

What would prevent you from passing a physical examination?  _________
______________________________________________________________________
______________________________________________________________________ 


DRIVING RECORD

What driver's license do you hold? _____________  
License No. _______________

Have you ever had your driver's license suspended, canceled or denied in
any state? ___ Yes ___ No   If yes, Why? _______________________________
________________________________________________________________________

Any major violations in the last three (3) years? ______________________
________________________________________________________________________

Do you make it a habit to drink alcohol in excess? ___ Yes  ___ No

Have you ever been convicted of a crime? ___ Yes ___ No


SCHOOLING

Are you a High School Graduate?  ___ Yes ___ No  
Grade completed  7 8 9 10 11 12

Have you previously attended another college, business school, trade 
school or technical school?  ___ Yes ___ No

Show special courses or training that will help you as a driver. 
____________________________________________________________________
____________________________________________________________________

Which safe driving awards do you hold and from whom? _______________
____________________________________________________________________
____________________________________________________________________
 

DOMESTIC SITUATION

___ Married  ___ Single  ___ Divorced ___ Separated ___ Widowed

Wife's/Husband's Name __________________ Age ___ No. of Children _____
 
Spouses's Employer ________________ How Long? ___ Monthly Wages ______


WORK RECORD

Cover all positions.  Report last position first, dating back (3) years.
(Employer will not be contacted.)

PRESENT EMPLOYER ____________________ Address _________________________

How long employed? ____ Starting Salary ______ Present Salary _________

Why are you dissatisfied with your present job?  ______________________
_______________________________________________________________________ 
                                                          
                Name               Address            Length of Service
Past Employer _________________________________________________________
              _________________________________________________________
              _________________________________________________________


PRESENT FINANCIAL SITUATION

Do you  ___ Own your Home  ___ Rent  ___ Live with relatives
Give Landlord's Name __________________________________________________
Name of Bank or Savings Institution ___________________________________ 
Address _______________________ City _____________ State ______________
___ Savings Account? ___ Checking Account? ___ Loan Account? __________
How do you estimate your credit rating?  ___ Excellent  ___ Good ___ Fair
___ Poor
List two (2) additional Credit References ____________________________
______________________________________________________________________



(I further understand that I have read the entire forgoing application 
and that all answers, statements, and all other matters therein are 
true.)

Signature _____________________________________________Date ____________


                           Amercia's Driving Force
                   PO Box 16845, Atlanta, Georgia 30321
                  Phone: 404-608-8608, Fax: 404-608-9608