International Institute of Transportation Resource, INC
School Information
Locations
Class Schedule
Tuition & Payment Info
Job Placement
Testimonials
Our Staff
Links
blank image spacer
Training Programs
Refresher Training
CDL Testing
Our Fleet
blank image spacer


Driving Directions to:
Portland Campus
Eugene Campus
Medford Campus
Bend Campus
Albany Campus


Employment Counselors Click Here

Contact us by Phone:
Portland/Redmond
1-888-438-2235
503-656-IITR

Eugene/Albany/Medford
1-800-976-7612
541-895-5525


 

Truck

Pre-Enrollment
Questionnaire

Please Fill out entirely
First Name:  
Last Name:  
Age:  
Home Phone Number:     (ex. 503-123-4567 )
 Email:  
Home Address:  
City:  
State:  
Zip Code:  

Please answer the following questions. If your answer is yes to any question, please explain in the space provided.

01) In the last 5 years, have you been convicted of more than 3 moving violations or any speeding in excess of 15 mph over the speed limit?
No Yes     If yes, you must explain:
 
02) Have you been involved in more than 1 accident in the past 5 years?
No Yes     If yes, how many and were they your fault?
 
03) Have you been convicted of any major violations in the last 5 years? (careless, negligent, reckless, hit & run, eluding, etc.)
No Yes     If yes, you must explain:
 
04) Do you have any alcohol-related violations (breath failure, DUI, DWI, MIP, Diversion, etc.) in the last 5 years, or have you ever had more than 1?
No Yes     If yes, you must explain:
 
05) Has your driver's license been suspended or revoked in any state in the last 5 years?
No Yes     If yes, you must explain:
 
06) Do you have any felony or misdemeanor convictions?
No Yes     If yes, when and what for?
 
07) Do you have any difficulty reading, writing, or understanding English?
No Yes     If yes, you must explain:
 
08) Do you currently have or have you ever had any physical problems such as a bad back, neck, leg, etc., or do you have any of the following problems: vision problems in either eye, diabetes, hearing problems, epilepsy, high blood pressure, or lifting limitations? (You must pass a DOT physical and NIDA drug screen)
No Yes     If yes, you must explain:
 
09) Is driving a vehicle with a clutch a new experience to you or do you anticipate it being a problem?
No Yes     If yes, you must explain:
 
10) If you are old enough are you able to provide your 10 year work history?
No Yes     If no, you must explain:
 
All potential students must understand that a bad work history, driving record, criminal background, physical problems, mental or social problems, will limit your employment opportunities as a tractor-trailer driver.
 
11) What source of advertisement brought you to IITR?
 

If other:

 
12) What is your previous employment experience? (what have you done)
 
13) What is your educational background? (IITR students are required to provide proof)
High School Education
 

If other: 

Number of years of College

 
14) What type of employment do you desire if you attend and graduate from IITR?
 
 
15) If I attend, I plan to pay my tuition by the method checked below:
 

Additional Explanation:

 
16) My Credit is: (only for those applying for a Loan)
 
If you have poor credit can you obtain a cosigner? No Yes
17) COMMENTS - If you have spoken with an IITR representative, please detail this conversation below.
 
18)Mandatory questions required by our Licensing Agencies

Are you a U.S. Citizen or have proof of your Legal Right to Live or Work in the U.S?
 
Race:
 

If other, please fill in below:

Final e-mail Verification - Please re-enter your e-mail address.
 
Gender:  Male Female