test                    ANEW Application Form

PROGRAM INFORMATION



CDl Stuff

CDL Instructions


CONTACT INFORMATION











mobile messaging rates may apply



OUTREACH & RECRUITMENT INFORMATION





PRE-APPRENTICESHIP INFORMATION


















APPRENTICESHIP INFORMATION
EDUCATION INFORMATION



Enter none if not applicable

Enter none if not applicable




Enter none if not applicable

Enter none if not applicable




SELF IDENTIFICATION INFORMATION



















ADDITIONAL QUESTIONS

*These questions are intended to enhance our ability to better serve you, with no intention of restricting your access to our services.
Yes No Prefer not to disclose







COURT INVOLVEMENT
Please note we ask these questions to better assist you with placement into employment.













FINANCIAL COACHING INTAKE

As an ANEW client, you'll have access to free financial coaching. This coaching is designed to help you improve your financial well-being and achieve your financial goals.

The information you provide will help your coach understand your current financial situation and tailor a plan to meet your specific needs.


Please note that the information you provide will be kept strictly confidential.
















Enter only the number not the dollar sign


Enter only the number not the dollar sign





Other types of income- please provide monthly amount, enter 0 if not recieved

Enter only the number not the dollar sign

Enter only the number not the dollar sign

Enter only the number not the dollar sign

Enter only the number not the dollar sign

Enter only the number not the dollar sign

Enter only the number not the dollar sign

Enter only the number not the dollar sign

Enter only the number not the dollar sign


























income

Page 4

ADDRESS HISTORY FOR THE PAST 3 YEARS

List all address' held for the past 3 years. Click "Add another response" link to add more.





DRIVER LICENSE INFORMATION

No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below.











PREVIOUS LICENSE INFORMATION

List all licenses held for the past 3 years. Click "Add another response" link to add more.




DRIVING EXPEREINCE





ACCIDENT RECORD FOR THE PAST 3 YEARS





TRAFFIC CONVICTION AND FORFEITURESS FOR THE PAST 3 YEARS




EMPLOYMENT INFORMATION

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years.

Start with the last or current position, including any military experience, and work backwards. You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.













EMPLOYMENT HISTORY FOR THE PAST 3 YEARS












TO BE READ AND SIGNED BY APPLICANT
I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.

I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:
  • Review information provided by current/previous employers;
  • Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations



EMERGENCY CONTACT:




INFORMATION VERIFICATION STATEMENT:

Please read the statements below and input your initials.





NON-DISCRIMINATION POLICY:
ANEW follows the equal opportunity employment and training policy and does not discriminate on the basis of race, creed, color, ethnicity, national origin, religion, sex, sexual orientation, gender expression, age, physical or mental ability, veteran status, military obligations, background, or marital status.


By digitally writing in my name, I agree to have it act as my signature.
Passports Agreement
The Passport to Careers program helps former foster youth and unaccompanied homeless youth prepare for and succeed in college, apprenticeships, or pre-apprenticeship programs. Under the Passport to Careers Program, there are two subprograms:
  • Passport to College
  • Passport to Apprenticeship
ANEW is to provide state financial assistance to former foster youth and unaccompanied homeless youth whom are interested in or currently participating in state-approved, federally registered, or reciprocally recognized pre-apprenticeship and apprenticeship programs that are not based on a college campus. 


I agree to the following (input your initials):








If you have any questions, please contact ANEW Passport program.

We are here to help: passport@anewcareer.org

Contact Information