Advanced Manufacturing Technician Program Intake Form

Applicant Information

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First Name

Eligibility Information

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Middle Name

Are you 18 years of age or older?

- Select -No

By pressing the Submit button, I agree to the terms below:

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Last Name

Are you a Maryland resident?

- Select -No

Terms1

- Select -

Street Address

Do you have a valid Maryland Driver's License?

- Select -No

Terms2

- Select -

Apartment #

If no, please explain

City

Do you have any past driving history/infractions that may impact your ability to obtain a commercial license?

- Select -No

If yes, please explain

State

- Select -Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Do you have a high school diploma or GED?

- Select -No

Zip Code

Have you been convicted of a crime or served time for a conviction?

- Select -No

If yes, please explain

County

Employment Status

- Select -Part-time Unemployed

Home Phone

If employed what is your highest hourly rate?

Cell Phone

What is your highest educational attainment?

- Select -Some College Associates Degree Bachelor's Degree Master's Degree Industry Credential

Email

Industry credential (Please specify)

Race

- None -Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic/Latino

Are you eligible to work in the United States?

- Select -No

Are you available for training classes one evening every week?

- Select -No

Are you available for training classes on Saturdays?

- Select -No

Do you work for one of the following companies?

- None -Caldwell Manufacturing Fil Tec, Inc. Rust-Oleum Wright Manufacturing Jamison Door Company