Contact Us

Questions about the program...

Your Name
Email Address

 

Contact us at
 PREMIER DRIVING ACADEMY INC.
7601 THEDORE DAWES ROAD

THEODORE, AL. 36582

OFFICE HOURS
 MON-THUR 8-6

FRI 8-5

 

PHONE 251-653-5235

TOLL FREE 877-653-5235
 FAX 251-653-5245

 Notes

 APPLY ON-LINE TODAY. (PLEASE UNDERSTAND THAT IN COMPLETING THIS APPLICATION THE SCHOOL IS UNDER NO OBLIGATION TO ACCEPT YOU NOR ARE YOU UNDER ANY OBLIGATION TO THE SCHOOL.) THIS QUESTIONNAIRE IS USED ONLY TO DETERMINE YOUR ELIGIBILITY, JOB OPPORTUNITIES, AND THE BEST WAY TO GET YOU THROUGH THE PROGRAM.

DATE:

NAME: PHONE:

EMAIL ADDRESS(WILL BE USED FOR CONFORMATION EMAIL):

PRESENT ADDRESS:

HOW LONG:

PREVIOUS ADDRESS:

HOW LONG:

AGE:  DATE OF BIRTH:  SOCIAL SECURITY NUMBER:  

HEALTH



 DATE OF LAST PHYSICAL:   RESULTS:

ARE YOU CURRENTLY TAKING ANY MEDICATIONS: YES NO 

IF YES, PLEASE DESCRIBE:

DRIVING RECORD / BACKGROUND(USED FOR JOB PLACEMENT)

WHAT CLASS DRIVER'S LICENSE DO YOU HOLD: 

LICENSE NUMBER: 

WHAT STATE'S HAVE YOU HELD A LICENSE IN THE LAST THREE YEARS:

HAS YOUR DRIVER'S LICENSE EVER BEEN SUSPENDED, CANCELED,  OR DENIED IN ANY STATE:                                YESNO   IF YES, WHEN AND WHY:

PLEASE LIST ALL MOVING VIOLATIONS OR ACCIDENTS THAT OCCURRED  IN THE LAST THREE YEARS:

HAVE YOU EVER BEEN CONVICTED OF A DUI/DWI:YES NO 

IF YES,WHEN:  

HAVE YOU EVER BEEN CONVICTED OF A FELONY: YES NO

IF YES, WHEN:

HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR: YES NO

IF YES, WHEN:

SCHOOLING/MILITARY

ARE YOU A HIGH SCHOOL GRADUATE(NOT REQUIRED FOR PROGRAM ADMITTANCE):

YES NO

HAVE YOU PREVIOUSLY ATTENDED ANOTHER COLLAGE, BUSINESS, TRADE, OR TECHNICAL SCHOOL: YES NO

HAVE YOU EVER SERVED IN THE MILITARY: YESNO  IF YES, BRANCH:

SERVICE DATES: FROM TO

WORK RECORD

PLEASE COVER ALL JOBS DATING BACK THREE YEARS, RECORD PRESENT POSITION FIRST, IF UNEMPLOYED PLEASE LIST "UNEMPLOYED" AS WELL AS REASON FOR LOSS OF JOB(QUIT, DISCHARGED, LAID OFF, ECT.)

  • PRESENT EMPLOYER:ADDRESS: 

      HOW LONG EMPLOYED: PRESENT SALARY:

      WHY ARE YOU DISSATISFIED WITH YOUR CURRENT JOB:

      PHONE NUMBER:

  • PAST EMPLOYERS                                                                                                                                                                          NAME: ADDRESS:                                                            PHONE NUMBER:  LENGTH OF SERVICE:
  • NAME:  ADDRESS:                                                       PHONE NUMBER:  LENGTH OF SERVICE:
  • NAME:  ADDRESS:                                                              PHONE NUMBER:  LENGTH OF SERVICE:
  • NAME:  ADDRESS:                                                              PHONE NUMBER:  LENGTH OF SERVICE:
  • NAME: ADDRESS:                                                               PHONE NUMBER:  LENGTH OF SERVICE:                                                                                                                                                                                                                                                   IF I AM ACCEPTED FOR ENROLLMENT, I AUTHORIZE PREMIER TO FORWARD INFORMATION FROM THIS APPLICATION AND/OR OTHER SCHOOL RECORDS TO PROSPECTIVE EMPLOYERS. THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS TRUE IN SUBSTANCE AND IN FACT.

 

WE LOOK FORWARD TO HEARING FROM YOU AND WILL CONTACT YOU AS SOON AS POSSIBLE.   

SUBMIT