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Commercial Driving School application form
Bradway Trucking, Inc.

CUMBERLAND COUNTY COLLEGE COMMERCIAL DRIVING SCHOOL
(888) 333-7443 / (856) 692-5331
1040 NORTH BREWSTER ROAD
VINELAND, NJ 08361

Dear Applicant,

We are pleased that you have shown interest in our Commercial Driving Course. If you are seriously considering a career in the trucking industry please call the school to arrange an interview. If you are unemployed, underemployed or seeking a different career, you may qualify for assistance from your local WIA/WDP office. To better assist you, please fill out this questionnaire and return it to us. At that time an appointment can be made with your local office. Feel free to contact us at the number above with any questions or concerns you may have. Thank You.
Name *: City:
Address: State:
Email *: Zip:
SocSec#: Telephone Number *: Date of Birth:
Driver’s license number: State: Ever suspended or revoked?
yes no
Give details:
Please list all traffic convictions (other than parking) in the past 3 years:
List all traffic accidents in the past 3 years:
Are you working now? yes no
  List your last three employers: Dates: Position: Reason for leaving:
1)
2)
3)
Have your driving privileges ever been suspended or revoked? yes no
Give details:

Have you ever been convicted of a felony?

 yes no
Give details:
What method of payment will you use for this course?
a. Self b. Personal Loan c. WIA/WDP d. Other means:
How did you hear about the school?
Newspaper Billboard Web Search Other
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Bradway Trucking, Inc.
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