I have not failed. I’ve just found 10,000 ways that won’t work. ~ Thomas A. Edison

Apply Now for Admission to ACT!

sign-up-imagePlease complete the application form below. Protecting your private information is our priority. ACTION CAREER TRAINING does not sell, rent or lease your personal information to third parties. The information provided in this application will be released to prospective employers only. Information marked with * are required.

step1

Complete this Admissions Application form below.

 

step2

Then, after you complete Step 1… IF (and only IF) you need financial assistance, complete the Application for Credit.



CONTACT INFORMATION

Your Name*

Address*

City* State*

Zip Code*

Phone* Email*


SS# - For security reasons, ACT will request this information via telephone.

Are you a U.S. Citizen? YesNo

How did you hear about ACTION CAREER TRAINING?




PERSONAL HISTORY

Date of Birth

Marital Status MarriedSingle

Number of Dependants

Military Experience? YesNo

If yes, how long in the Military?

If yes, Date of Discharge

If yes, Type of Discharge


Date of Last Physical

I certify, to the best of my knowledge, I am in good physical condition: YesNo



BACKGROUND AND DRIVING HISTORY

Have you ever been convicted of a felony? YesNo

If Yes, Date of Felony Conviction

Nature of Conviction (explain below)


Have you ever been convicted of a misdemeanor? YesNo

If Yes, Date of Misdemeanor Conviction

Nature of Conviction (explain below)


Have you ever been convicted of a DWI or DUI? YesNo

If Yes, Date of DWI or DUI Conviction


List All Drivers Licenses held in the Last 3 Years.

For security reasons, ACT will request your driver's license number(s) via telephone.

State Class Expiration Date

State Class Expiration Date

State Class Expiration Date


Number of Moving Violations in the Past 3 Years

1st Date of Violation
2nd Date of Violation


ACCIDENT REVIEW FOR PAST 5 YEARS

Last Accident Date
Fatalities? YesNo Injuries? YesNo

Previous Accident Date
Fatalities? YesNo Injuries? YesNo




EDUCATIONAL AND EMPLOYMENT HISTORY


Highest Grade Completed?
High School Diploma? YesNo
GED? YesNo

College Years Completed


EMPLOYMENT - The U.S. Department of Transportation requires that driver applicants show all employment for the past three years. Effective July 1987, they must also show commercial driver employment for the seven years immediately preceding this three-year
period.

Start with last or current position, including military experience, and work background.


Current Employer

Supervisor's Name

Address

Phone

Position Held

From To

Salary

Reason for Leaving (explain below)


Previous Employer

Supervisor's Name

Address

Phone

Position Held

From To

Salary

Reason for Leaving (explain below)


By submitting this form, I hereby authorize, without liability, any person or organization whose name I have given as reference, or by whom I have been previously employed, to furnish Action Career Training any information they may have concerning my character, habits, financial responsibility, credit history, job performance, etc.

I hereby authorize any law enforcement agency or court of record to furnish Action Career Training any information concerning motor vehicle report, or any felony or misdemeanor of which I have been convicted. I authorize, without reservation, any or party or agency contacted by DAC to furnish the above mentioned information.

This certifies that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. False, misleading, or incomplete statement of the information requested in this application shall be sufficient cause for termination from training.


Before clicking the "Submit Application" button, please review all information provided above to ensure that it is correct.