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Register for a Class

(Ability to Benefits)

SKAGIT CITY TRUCKING SCHOOL
2418 Old Hwy 99 South
Mt Vernon, WA. 98273

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* Which class are you registering for?

Personal

* Your Name

* Home Phone
Cell Phone

* Email
* Date of Birth

* Address
* City

* State
* Zip

How did you hear about Skagit City Trucking School?

Education

Do you have a High School diploma?
 Yes No
Years in college

Degree
Certificates

Last Grade Completed

Military

Are you a Veteran of the U.S. Armed Forces?
 Yes No

Health

Have you ever had or have any of the following?
 Diabetes Hearing Loss Vision Loss Epilepsy High Blood Pressure Lifting Limitations Physical Problems (such as bad back, legs, or other) Any Disability
Explain: (only if you answered yes to any above question)

Employment

What type of employment do you desire after Graduating from Skagit City Trucking School?
 Long Haul Local Regional Owner Operator

Legal

In the last 3 years, have you been convicted 3 or more moving violations?
 Yes No
If yes, explain:
In the last 3 years were you cited for speeding 15 mph or more?
 Yes No
If yes, explain:

Have you been involved in more than 1 accident in the last three years?
 Yes No
If yes, explain:
Do you have any alcohol related violations in the last 5 years? (DUI, DWI, etc)
 Yes No
If yes, explain:

Has your license been revoked/suspended in any state in the last 5 years?
 Yes No
If yes, explain:
Do you have any outstanding traffic violations , fines, or federal debts?
 Yes No
If yes, explain:

Have you ever been convicted of a misdemeanor or felony?
 Yes No
If yes, explain:
Do you have any difficulty reading, writing, speaking or understanding the English language?
 Yes No
If yes, explain:

Have you ever driven a Tractor Trailer or straight truck?
 Yes No
If yes, explain:

Drug and alcohol testing is required in the trucking industry under Federal Motor Carrier Regulations. Passing the Department of Transportation Physical is also a requirement under D.O.T. regulations and is required in order to be admitted into Skagit City Trucking School. By Signing below you acknowledge that you will undergo these tests and that the information provided is true.

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