Online Qualification Application...

Please complete this form for a determination of acceptability and financial qualification for the National Heavy Equipment Operator School. Since this information you provide will be transmitted in a secure mode, please answer each question completely (leave no questions unanswered) or we may be unable to process your request. The information you provide will be held in the strictest confidence. By submitting this application, you authorize National Training Inc. to check your credit whether or not your application is signed. You are in no way obligating yourself to the School by completing this application.

Last Name: First Name:
Middle Initial:

Social Security Number:

Address:

City:

State: Zip:

How Long at Address: Years Months

Phone:

Email:

Do you Own or Rent    Monthly Cost $:

Date of Birth:

Driver License#: State Licensed:

If Married, Spouse Name:
(If not married please enter NA)

Your Spouse's Employer:
(If not married please enter NA)

Your Current Employer:

Current Position:

Current Income

How Long have you held this position?: Years Months

Previous Employer:

Previous Position:

Date From: Date To:

Previous Wages:

Personal Reference Name:

Relationship:

Address:

City:

State:

Zip:    Phone:

Your Last or Current Monthly Income: $ per Month

Spouse's Last or Current Monthly Income:$ per Month

Other Income: $ per Month

What was the other income from?:

Have you ever had a Student Loan?:

Any Student Loans in Default?:

Have You ever filed Bankruptcy?: Date?:

Will You Need Financial Assistance:

Do you have a Cosigner?:

If yes, complete following:

Cosigner Name:

Cosigner Phone:

Address:

City:

State: Zip:

Social Security Number

D.O.B.:
Note: We will seek permission from your cosigner prior to making any credit checks.

Employment Checklist
Please click a check mark in the box next to each question that applies to you.

1.

yes

Is your driver's license currently expired, suspended, invalid or without picture?...................................................................

2.

yes

Do you have any outstanding or unpaid traffic fines or citations in any state?...................................................................

3.

yes

Have you ever been convicted of a felony or use or possession of an illegal drug?...............................................................

4.

yes

Do you have any history of epilepsy or diabetes?........................................

5.

yes

Do you have any heart or cardiac problems?.......................................

6.

yes

Do you have high blood pressure which is uncontrollable by medication?.....................................

Please explain any yes answer to above questions
(include dates):

(Please be patient, it may take up to 30 seconds for the form to be submitted. You will be redirected to a new page)

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