About You
Your Name

Your Email

Phone

Current Home Address

Date Of Birth (Example: 01-01-2004)

Are you between the age of 18 and 24?
YesNo

Are you Male or Female?
MaleFemale

Have you ever been convicted of, or pled guilty, or no contest to a felony? Answering yes will not automatically disqualify you from consideration.
YesNo

Are you currently employed?
YesNo

If yes, may we contact your employer?
YesNo

Employer's Phone Number

What is your favorite hobby?

Do you enjoy working with your hands?
YesNo

Are you in need of the following in order to participate in our program? Check all that apply:
TransportationChild Care
Why are you interested in joining Petra Cares Automotive Training Program?

Are you committed to finishing our 8 week automotive training program?
YesNo

Emergency Information
Because we deal with heavy machinery, please provide the following:
Emergency Contact Name

Emergency Contact Phone

What is your relationship to this person

Do you have any medical conditions we should be aware of?
(seizures, food/medication allergies, diabetes)

If so, please list any medications you are currently taking for this condition.

Education & Skills
High School Name & location

Number of Years Attended

Did You Graduate?
YesNo

GED Program Name & location

Number of Years Attended

Did You Graduate?
YesNo

College Name & location

Number of Years Attended

Did You Graduate?
YesNo
Subjects Studied

Trade, Business or Correspondence Schools Name & location

Number of Years Attended

Did You Graduate?
YesNo
Subjects Studied

List any subjects of special study or special training/skills. For example, welding, automotive vocational training, etc.

Foreign Languages
Please list any languages you can speak.

Please list any languages you can read and write.

U.S. Military Service
Branch of Service:

Last Rank:

Classification of Discharge:

Dates of Service:

References
Give the names of (3) three persons no related to you, whom you have known at least 3 years.

References #1 Name

Address & Phone Number

Email

Company/Relationship

Years Acquainted

References #2 Name

Address & Phone Number

Email

Company/Relationship

Years Acquainted

References #3 Name

Address & Phone Number

Email

Company/Relationship

Years Acquainted

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