E.S.D. Truck Driving School, L.L.C

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					                                       E.S.D. Truck Driving School, L.L.C.
                                              1436 Shoal Creek Road
                                                Decatur, AL 35603
                                                  (866)432-0430
                                                Fax (256)432-2855
                                          Educating, Superior, Drivers
                                           email-recruiter@esdschool.com
               Admission Application, Job Application, Credit Application, Enrollment Application
The purpose of this application is to determine whether or not the applicant is qualified to operate Motor Carrier equipment according to the requirements of the Federal
Motor Carrier Safety Regulations and the company named above.
It is our policy to effect all students transactions including, but not limited to, recruitment & employment, without discrimination to ensure equal treatment of students
regardless of sex, race, religion, color, creed, national origin or ancestry, age, disability, marital status, sexual orientation, or political beliefs.



             Applying for:                 Experienced                Student      Todays Date


        Length of Experience:                                         Anticipated Start Date:                             Endorsements:


How did you hear about ESD?


Name                                                                                                   Date of Birth




                                     Address                                                        City                          State                      Zipcode




             Social Security #                      Drivers License Number              DL State                  Telephone Home                          Telephone Cell




Own, Rent, Live With, Other                                    How long years      Drivers license exp date




Previous Address if less than 2 years                                           City                   State              Zipcode             How long years
                        Employment Information: 3yrs verifiable with no gaps including unemployment and any others for 10 yrs



                                 Current Employer                                                  Address                                  City                  State        Zipcode




                  Phone                                    Position                                              Reason for leaving                                          Dates




                                    Employer                                                       Address                                  City                  State        Zipcode




                  Phone                                    Position                                              Reason for leaving                                          Dates




                                    Employer                                                       Address                                  City                  State        Zipcode




                  Phone                                    Position                                              Reason for leaving                                          Dates




                                    Employer                                                       Address                                  City                  State        Zipcode




                  Phone                                    Position                                              Reason for leaving                                          Dates




                                    Employer                                                       Address                                  City                  State        Zipcode




                  Phone                                    Position                                              Reason for leaving                                          Dates
                                  Employer                                                        Address                                      City             State              Zipcode




                  Phone                                  Position                                                    Reason for leaving                                          Dates
                                                                                     Personal References



                                      Name                                                        Address                                      City             State              Zipcode




                                 Relationship                                                Telephone home                               Telephone Cell




                                      Name                                                        Address                                      City             State              Zipcode




                                 Relationship                                                Telephone home                               Telephone Cell
                                                                                                 OTHER
DUI                    Yes               No                  Ever Failed or Refused a Prehire or Random Drug Test.            Yes                 No
DWI                    Yes               No                            Ever Failed or refused a Random Alcohol Test           Yes                 No
Public Intoxication    Yes               No                  If Yes, What company were you working for at the time?           Yes                 No
Misdemeanor            Yes               No                                                If yes, did you fail or Refuse?    Failed              Refused
Felony                 Yes               No                  Probation            Yes                   No
Travel Permit Avail.   Yes               No                  Incarcerated Yes                           No
If yes to any of the above questions please explain and put dates:




                                                                                         Military Status
  Have you served in the US Armed Forces? Yes                                     No               Dates                                                        Discharge Type

                               Driving Experience




Class of Equipment     date started      date ended          appx # miles                     Type of Vehicle                         Type of Trailers Pulled
                                                States Operated in for the last Five Years
     Southeast            East Coast         West Coast     All 48       Canada         Mexico                                       States
Accident Record Last 5 Years                                 if none write none
Injury                                   Fatality                                 Ticketed                                    Date                                  Location




Traffic Convictions & Forfeitures for last 5 years - other than parking violations if none write none
Date                                            Charge                                                  Fined/Suspended                                             Location
                                           Drivers License (List Each driver's license held in past 3 years)
State              Type           Endorsements    Exp Date                License Number




        Ever Been Denied a License, Permit or Privilege to operate a motor vehicle?              Yes                No
           Any License, Permit or Privilege ever been suspended or revoked?                      Yes                No
If Yes, When?          Year                       Length of time suspended
    Reason for Suspension
   Ever had a Reckless or Careless Driving ticket/Charge? Yes                    No              Year
Diesel Truck Driving Course Fee: $
Total Hours Required for Completion: 160 Clock Hours or 3 Weeks
Upon successful completion of the course, the applicant will receive a Certificate of completion.
The first lesson will begin: Date:                   Time:           7:00a.m.
Classes will meet Monday thru Friday from 7:00am until 5:00pm for training.
Days and times subject to change.
This agreement constitutes the contract between the school and the student, and no verbal assurances or
promises not contained herein shall bind the school or the student.
Each student will if needed receive one of each a DOT physical, Instant drug test, Drug Screen, CDL Written Test,
CDL Road Test, CDL Learners Permit paid for by ESD
If Student already has any of these the money will not be refunded to them
Any additional test more than mentioned above will be the student’s responsibility.
All students are required to pay for the State Drivers license.
Termination From Training:
A. Absences
1. Accumulated absences of more than 20 of total clock hours.
2. Participant; will be counseled by trainer of possible termination due to absences.
3. Failure to notify trainer when unable to attend.
A. Tardiness
1. Habitual Tardiness.
2. Habitual practice of leaving premises during the training day.
B. Conduct
1. Failure to participate in training activities.
2. Refusal to follow directions.
3. Failure to progress according to ability.
4. All students must represent school in a professional conduct.
C. Theft
1. Theft of ESD Truck Driving School Property.
2. Damage or destruction of property through neglect.
D. Alcoholic Beverages or Illicit Drugs
1. Zero tolerance for drugs and alcohol while enrolled in school at E.S.D. Truck Driving School, L.L.C.
E. Dismissal
Zero tolerance for drugs and alcohol while enrolled in school at E.S.D Truck Driving School. This includes lodging. Drug and alcohol use will result in
immediate dismissal with no refund.
Failure to complete prescribed course in 1 ½ times length of prescribed course.
Any terminated student may apply for readmission in written request form and can only be reinstated with
permission of the School Administrator. All Fees and Associated Cost will be paid upfront.
Cancellation and Refund Policy:
1. A refund will be granted to any student who cancels the enrollment contract within forty eight (48) hours (until midnight
of the second day excluding Saturdays, Sundays, or legal holidays) after the enrollment contract is signed by
the prospective student.
2. The student is considered as having entered training when the student has attended on regular class period of
instruction at the school.
3. The school shall make refunds to the student no later than (30) days after the student withdraws or is terminated from the
program. Proof of refund(s) shall be placed in the student’s file. Proof shall be a photo copy of the check
after it has cleared the bank. The check shall be copied front and back on the same sheet of paper, with the
number of the check from the front folded so that it shows at the same time the back is
4. The effective date of the termination, for refund purposes shall be the last day of attendance.
5. In the event a student withdraws or is dismissed from the school, a refund may be due. The amount of the refund will be
based on the following.
The first one hundred five dollars ($105) paid to the school by the student will be retained as an enrollment or application fee.
All amounts in excess of one hundred five dollars ($105) will be refunded on a pro rate basis. The pro rate basis will be based on the total
program hours (160), divided by the number of hours attended, times the tuition and the cost of expenses already given hotel, physical, test fees,
etc. cost of expenses shall be based upon bills incurred while the student was enrolled.
Student Grievance and Complaints:
Any and all complaints must be written and turned into the School administrator for review and consideration.
Placement Assistance:
ESD Truck Driving School, L.L.C. does not guarantee employment, but will assist in job placement.
Other:
ESD Truck Driving School, L.L.C. does not guarantee the student to pass the test.
The undersigned certifies that he, or she, has read and received the school’s catalogue and this contract, and agrees to terms therein.
                                                               To Be Read and Signed by Applicant
It is agreed and understood that any misrepresentation given on the preceding pages shall be considered an act of dishonesty.
It is agreed and understood that ESD and motor carriers or his agents may investigate the applicant's background to ascertain any and all information
of concern to applicant's record, whether same is of record or not, and applicant releases employers and person named herein from all liability for all
damages on account of his furnishing such information

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508. I have been told that this investigation may include any
Investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.
I agree to furnish such additional information and complete such examinations as may be required to complete my file. It is agreed and understood that
this application for qualification in no way obligates ESD or motor carriers to employ the applicant. It is agreed and understood that if qualified, the
student/driver may be on a probationary period during which time he may be disqualified without recourse.

This certifies that this application was completed by me, and that all entrees on it and information in it are true and complete the best of my knowledge.
                                  Drug Screening Program, Consent form , General Release, Notification, Receipt
I have read and fully understand the E.S.D. Truck Driving School, L.L.C. "Drug Program" which is a zero tolerance drug and alcohol program which
includes alcohol & drug screening.
I acknowledge that drug & alcohol screening includes pre-admission/employment drug screens, periodic, random, post-accident and reasonable cause
testing drug & alcohol testing. I agree that the "Drug Program" is necessary for my safety and the safety of everyone on the highways of this country
and in the workplace. I agree to the "Drug Program" rules and further agree to submit to the drug screening policies and procedures of E.S.D. as a
condition of student, employment, or contract. I also understood as a student qualified, or student applying to be qualified, to operate a motor vehicle in
the services of E.S.D., do hereby consent and agree to the following:
I agree to submit to any E.S.D. collection site for them to collect a urine sample at the request of ESD for the purposes of detecting the possible
presence of certain substances by means of Drug Screening Urinalysis Laboratory Analysis. I also agree to submit to any E.S.D. selected collection
site for them to obtain a breath alcohol test at the request of E.S.D.for the purposes of detecting any alcohol.
I, as student/driver, authorize the hospital(s), or doctor (s) to release hospital(s) reports and/or doctor(s) reports and other documents that would
indicate whether there were any controlled substances/alcohol in my system if I am seriously injured in a reportable accident (where I receive a citation
for a moving traffic violation arising from the accident and cannot provide a specimen at the time of the accident).
I acknowledge and agree that the results of the test(s) may be released to ESD and that the results of the test(s) may be used to make decisions
affecting my qualification and/or requalification as a student and or perspective driver.

I have read this Consent and Release, fully understand & acknowledge that I have agreed to the release of the results of my tests to E.S.D. Truck
Driving School, L.L.C., from any and all claims, actions, or causes of action or rights which I may or might have arising from or resulting from the
actions taken by ESD with regard to my continued qualification and/or requalification as an student and or perspective driver.
      This certifies that this application was completed by me, and that all entries on it and information are complete to the best of my knowledge.
I Authorize E.S.D. Truck Driving School, L.L.C. and others perspective employers to check my credit, verify bank information,
check my information, check my employment history and contact my references and release information to potential employers.
                                                                                           E.S.D. Truck Driving School, L.L.C.
                                                                                         1436 Shoal Creek Road, Decatur, Al 35603
                                                                                       866-432-0430 Fax 256-432-2855
                          Signature/date                                                email-recruiter@esdschool.com