Valentine’s Driving School Inc.
CDL Online Application / Registration Information
Age Group: _____21-30 _____31-40 _____41-50_____51-60 _____61 +
Highest Education:
Name and Location of Highest
School___________________________________________________________
Highest Grade Completed _____________ Year Graduated ________________
Professional Development:
_____ Driver Improvement Program _____ Road Evaluation
_____ CDL Type B w/Restrictions _____ CDL Up-grade to B
w/Restriction
_____ CDL Type B Non-Restrictions _____ CDL Up-grade to B
Non-Restriction
_____ CDL Type A-z w/Restrictions _____ CDL Up-grade to A-z
w/Restriction
_____ CDL Type A Tractor Trailer _____ CDL Up-grade to A Tractor
Trailer
_____ Hazmat _____ Tanker
_____ Combination _____ Double & Triple
_____ Passenger
Preference Available:
Days: ____ Mon ____ Tues. ____ Wed. ____ Thurs. ____ Fri. ____ Sat.
____ Sun.
Times: _____ AM ________________________ to _______________________
PM ___________________________ to __________________________
Evening’s ________________________ to __________________________
Name___________________________________________________________
Driver License Number______________________________
Expiration______________
Phone (H) _______________ (W) _______________ (Cell) ________________
Email Address_________________________________________________________
Address_________________________________________________________
City________________________ State__________________
Zip__________________
Date of Birth________________________________
Place of Employment:
________________________________________________________________
Years of Service: _________________
Position Title: __________________________________________
Payment Method: Cash ___________ Check # __________________ Money Order_________________
Travlers Check ___________________PO # ____________________________Company________________________
If special assistance is required, please describe
________________________________________________________________
Course # Course Title Date Tuition
________ __________________________ _____________ ______________
________ __________________________ _____________ ______________
________ __________________________ _____________ _____________
Tax 4.712% $________________
Total Amount Due $ ____________
Tuition Payment for CDL only: Fifty percent of tuition is due on first day of instruction. Balance due on last day of instruction.
Make-Up Sessions: If unable to attend any scheduled Instruction Student must call Instructor two hours before scheduled instruction appointment. Student will be responsible for make-up session charge of $50.00 min of two hours session. Make-up charge must be paid in cash before the next schedule instruction session.
Equal Opportunity:
Valentine’s Driving School Inc. Promotes equal employment opportunity and prohibits discrimination in employment because of race, color, religion, sex, national original, age, sexual orientation or disability.
Pre-requisites and Grading System (for CDL):
Passing Grade is 80% of General Knowledge, Air Brake and all CDL endorsements.
Student must:
* Be able to read, speak and understand English
* Attend at least 95% of scheduled classes
* Pass the City & county Pre-Inspection, Basic Skills, and Road Test (Behind the wheel).
Student Signature____________________________________________ Date_________________________