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Rocky Mtn Truck School
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Course Descriptions
To apply for school, print this application and mail back to us at
4510 Broadway SW, Albuquerque, NM 87105
or fax to (505) 888-5236.
Class Date you are applying for: ________________________
Last Name:________________________________   First Name: _____________________________
Address: __________________________________  Phone # :  ______________________________
              __________________________________    Cell # :    ______________________________
Veteran Status (optional) _____________________
Employment History:
Current/past employer: ___________________________  Phone #  ___________________________
       Current position or reason for leaving:  _______________________________________________
Emergency Contact:
Name: ____________________________________ Phone # :  _______________________________
Address: __________________________________  Relation:  _______________________________
Reference (not related):
Name: ____________________________________ Phone # : ________________________________
Address: __________________________________
The following questions will assist in identifying any possible area(s) that should be discussed regarding your future employment with a truck company.  (Note:  Questions are optional and are used for job placement/student financing purposes only.)  Please answer yes or no
1)  Is your employment/education history verifiable for the past three (3) years?                 _________
2)  Did you graduate high school/GED (informational only/not required for school).           _________
3)  Have you had your driver's license for at least one year?                                                  _________
4)  Do you have any disabilities that would prohibit you from driving? (Per DOT                _________
         guidelines) Explain: ________________________________________________
5)  Do you presently take any form of prescription medication? (Per DOT                            _________
        guidelines)  Explain: ________________________________________________
6)  Are you a US Citizen or Permanent Resident?                                                                    _________
7)  Has your driver's license been suspended or revoked within the past 3 years?                   _________
         If yes, date: ___________________________________________________
8) Have you ever been convicted of a DUI/DWI?                                                                     _________
         If yes, date: ___________________________________________________
9) Have you had any vehicular accident(s) in the past 3 years?                                                _________
         If yes & at fault, date: ___________________________________________
10) Have you received any driving/traffic tickets in the past 3 years?                                     _________
         If yes, what/date: _______________________________________________
11) Have you ever been convicted for possession, sale or use of an illegal drug or
         other controlled substance?                                                                                              _________
         If yes, date: ___________________________________________________
12)  Have you ever been convicted of a crime (misdemeanor or felony) or are any
         charges pending?                                                                                                              _________
         If yes, date: ___________________________________________________
13)  Do you have any travel restrictions?                                                                                 _________
14)  Do you have any medical/lifting restrictions?                                                                   _________
15)  Tuition will be paid by (circle one) cash, credit card, payment plan, other                        ________
I certify that all the information given above is correct and complete to the best of my knowledge.  I agree that my enrollment is based on the facts that I have given and any intentional misrepresentation on my part will constitute a release to the school for any liability that may be encountered by having acted on such facts.  I have read the above and understand it.  I hereby authorize Rocky Mountain Truck Driving School to investigate and verify facts claimed by me on this application.
Signature: ____________________________________    Date: _______________________________
Name (please print): ____________________________
If you have questions or would like the student application/current brochure mailed to you, then please email us at rmtds1@aol.com and give us your complete name/address or provide your phone number if you would like to be contacted by phone.  Office phone numbers: (505) 888-5182 fax (505) 888-5236