RJ Elite CDL Training
(901)-490-1078
Rjelitecdltraining@gmail.com
9991 hwy 178 Ste 1 olive branch, ms 38654
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Age
First Name
Last Name
State of Birth
Date of birth
Address
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Cell Phone
Driver License Number
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Can you pass Drug Screen & Physical
Yes
No
Are you taking any medications?
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No
Driving Record
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No tickets / accidents in past 3 years
1-2 tickets / accidents in past 3 years
3 or more tickets / accidents in past 3 years
DUI/DWI/Reckless Driving in last 3 years?
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No
Criminal Convictions?
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None
Misdemeanor
Felony
Used illegal drugs in the last year?
Yes
No
Current Legal Status
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U.S. Citizen
Resident Alien
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Current Work Status
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Employed
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Number of jobs held in the last five years
When do you want to start training?
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Next class
Within a month
Within six months
Not sure
Tuition Options
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I will provide my own tuition.
I will need financing for my tuition.
I will my V.A. Benefits
Current Credit Standing
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Good/Fair
Excellent
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