Big Rig Truck Driving School

This application will be used to see if you qualify for the school and the trucking industry. Please answer completely. All replies are confidential. We will notify you whether you qualify or not.

Required - *

*Last Name:
*First Name:
*Street Address:
*City:
*State:
*Zip:
*Telephone:
*E-mail:
*Birth Date: (mm/dd/yy)

*Tickets or accidents in last three years?		Yes No
*Drivers License Number:		State:
*Illegal Drug use in last three years?		Yes No
*Criminal convictions in last 5 years?		Yes No
*Currently working?		Yes No
Where:		How Long?

Filling out this form and submitting it to Big Rig is authorization for Big Rig to obtain a copy of your Motor Vehicle record.

Comments/questions: