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Yuba City, CA

Student Application

Call 530-822-1540

Yuba City, CA

Student Application

Call 530-822-1540

Student Application

Call 530-822-1540

Application for Training

The submission of the application does not automatically approve admission.

Tri Counties Truck Driving School reserves the right to review each application thoroughly before determining the applicants status of admission.

Name *

First Name

Last Name

Date of Birth *

Phone *

(###)

###

####

Email *

Driver's License # *

Class Type *

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a US Citizen?

Are you a veteran? *

Have you ever been convicted of a felony? *

if yes, explain

Highest Level of Education Completed *

GED

High School

Undergraduate

Graduate

Vocational or Other

None of the Above

Employment History

top 2-3 most recent

Have you had a moving violation in the last 3 years? *

yes

no

if yes, explain *

Have you had an accident in the last three years? *

yes

no

if yes, how many?

Do you have a record of careless or reckless driving in the last 7 years? *

yes

no

if yes, explain

Do you have any restrictions on your license? *

yes

no

if yes, explain

DOT physical exams are necessary for every accepted applicant. Please review the following items required in the DOT exams. *

check any that apply

Color Blind

Hearing Loss

Fainting Spells

Epilepsy

Vision Loss

Diabetes

High Blood Pressure

Medication

Medication List:

Please list any medication you are taking

How did you hear about us?

Emergency Contact Information

Reference #1 *

Name: Phone #: Relationship:

Reference #2 *

Name: Phone #: Relationship:

Reference #3 *

Name: Phone #: Relationship:

Please print your full name *

Signature

Date

MM

DD

YYYY

Thank you!

Still have questions?

Click below to submit your question and one of our team members will reach out to you.

First Name

Last Name

Email *

Question *

Thank you!