Del Mar College Transportation Training Services Application

You may fill out the following form and submit it electronically or you may print and submit the application by mail or in person.

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PRINTABLE APPLICATION

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ONLINE APPLICATION

Name: Date of Birth:     Street: City: State: Zip: Home Phone: Work Phone: E-Mail:         PERSONAL HISTORY Marital Status: SINGLE MARRIED Spouse's Name: Military Experience: YES NO How Long?: Date Discharged: Branch: Citizen of:         PHYSICAL HISTORY Are you in good health? YES NO Do you have at least 20/40 vision in each eye with glasses? YES NO Do you have good use of hands/arms? YES NO   Feet? YES NO   Legs? YES NO   Good hearing? YES NO Do you have any condition that could cause fainting spells? YES NO Have you ever been treated for:     Diabetes? YES NO   Epilepsy? YES NO   Heart? YES NO   Other? YES NO Use of intoxicants: HABITUAL OCCASIONAL SELDOM NOT AT ALL Use of drugs: HABITUAL OCCASIONAL SELDOM NOT AT ALL Any physical defects? YES NO   Describe: Date of last physical:           EDUCATIONAL HISTORY Highest Grade Completed: 1 2 3 4 5 6 7 8 9 10 11 12 High School Diploma YES NO GED: YES NO   EMPLOYMENT RECORD The U.S. Department of Transportation requires that driver applicants show all employment for the seven years immediately preceding this three-year period.     S391.21(b) (10), (11). Current Employer: Address: Phone: Position Held: From: To: Salary: Length of Employment:       Previous Employer: Address: Phone:   Position Held: From: To: Salary:   Length of Employment:         Previous Employer: Address: Phone:   Position Held: From: To: Salary:   Length of Employment:         DRIVER EXPERIENCE AND QUALITY Driver Licenses held in the past 3 years: State: License No. Type: Expiration:         State: License No. Type: Expiration:         State: License No. Type: Expiration:         A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? YES NO   Date:   B. Has any license, permit or privilege ever been suspended or revoked? YES NO   Date:         If you answered "YES" to A or B, provide a statement giving details.         Accident Review for Past 3 Years Date: Nature of Accident (Head-on, Rear-end, etc.) Fatalities: YES NO Injuries: YES NO         Date: Nature of Accident (Head-on, Rear-end, etc.) Fatalities: YES NO Injuries: YES NO         Date: Nature of Accident (Head-on, Rear-end, etc.) Fatalities: YES NO Injuries: YES NO         Convictions, Felonies, and/or Forfeitures for the past 10 yrs other than Parking Violations Date State: Charge:         Date State: Charge:         Date State: Charge:         I understand that in completing this application Del Mar College is under no obligation to accept me, nor am I under obligation to Del Mar College. It is agreed and understood that the answers to the foregoing questions have been supplied by me and are true and correct to the best of my knowledge and that any misrepresentation of information given above shall be considered an act of dishonesty.