Application for Enrollment

This completed form will help us determine if you qualify for training. Please understand that the school is under no obligation to accept you, nor are you under any obligation to the school by completing this Qualifying Form.

Name

Social Security #

Date of Birth

Physical Address

Country

City

State

Zip code

Mailing Address (if different)

Country

City

State

Zip code

Home Phone

Cell Phone

Other Contact Number

Gender

Male

Female

US Citizen?

Yes

Other Ethnicity

City and State of Birth

Do you speak, read and understand English?

Yes

How will you finance your education if accepted?

WIOA

Vocational Rehab

Private Loan

GI Bill

What is your highest completed grade?

Name of High School

Address of High School

Year graduated from High School or received GED

Name of College

Address of College/University

Year graduated from College/University

We do offer job placement assistance. However, we do not guarantee employment.

Branch of US Military Service

Date Entered

Date Discharged

Name of Person to Contact in Case of Emergency

Telephone Number of Person to Contact in Case of Emergency

Employment Status (Select One)

Physical Limitations

We ask that you be candid in your answers. Having physical limitations, DOES NOT DISQUALIFY YOU from acceptance at A & K. These issues are considered on an individual basis. Simply be honest with us, and we will do our utmost to give you the accommodations you need to succeed.

Do you have any physical limitations?

Yes

If yes, please describe.

Do you have any learning disabilities?

Yes

If yes, please describe.

Do you take any medication that can prevent you from operating machinery?

Yes

If yes, please describe.

Criminal Record

Possessing a criminal record DOES NOT DISQUALIFY YOU from acceptance at A & K. All of these issues are considered on an individual basis. Simply be totally honest with us, and we will give you the benefit of any possible doubt. Our mission is to be the place that gives people the second chance they need to succeed and thrive. Our default mode is to believe in you. All we ask is that you be fully honest with us and try your best in your new career.

Are you on probation?

Yes

Have you ever been convicted of a felony?

Yes

If yes, please describe.

What was the nature of the offense?

Was the conviction for using illegal drugs?

Yes

If yes, what was the date of conviction?

Was this a 1st, 2nd or 3rd offense?

1st

2nd

3rd

Was the conviction for the selling of illegal drugs?

Yes

If so, what was the date of the conviction?

Two References Required

Name

Address

Phone

Name

Address

Phone

Required by the DMV

Driver's License Number

Date Issued

Have you ever been convicted of a DUI or DWI?

Yes

If yes, when?

Have you had a moving traffic violation during the past three years?

Yes

Can you drive a manual vehicle (5 speed)

Yes

Have you had any traffic accidents during the past three years?

Yes

If yes, how many?

Signature

Reset Signature

PLEASE CERTIFY THAT ALL OF THE ABOVE INFORMATION IS CORRECT AND VERIFIABLE TO THE BEST OF YOUR KNOWLEDGE

Your full name

Date

reCAPTCHA is required.

Application for Enrollment

We do offer job placement assistance. However, we do not guarantee employment.

Physical Limitations

Criminal Record

Two References Required

Required by the DMV

PLEASE CERTIFY THAT ALL OF THE ABOVE INFORMATION IS CORRECT AND VERIFIABLE TO THE BEST OF YOUR KNOWLEDGE

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