Qualification Questionnaire

If you have been directed here by a school representative, please complete this form. All fields are required to move forward with your school enrollment.

If you have not been in contact with a California Career School representative, please do not fill out the form below. Click back on your browser and click the tab “Request Program Information” and a representative will be in contact you.

First Name

Middle Name

Last Name

Phone Number

Address listed on your current Driver's License

Valid Residential Address in California (if different than Mailing address)

Date of Birth

Email

Drivers License

Drivers License State

Training Location

Start Date

Program

Training Length

Please provide 3 individuals that can serve as Personal References. Phone numbers must be distinct.

Reference 1

Reference Name

Reference Address, State, and Zip Code

Reference Phone Number

Relationship to Reference

Reference 2

Reference Name

Reference Address, State, and Zip Code

Reference Phone Number

Relationship to Reference

Reference 3

Reference Name

Reference Address, State, and Zip Code

Reference Phone Number

Relationship to Reference

Military Employment History

Branch of Service

Base Location

Current Status

Dates of Service

Enlistment Date (mm/dd/yyyy)

Separation Date (mm/dd/yyyy)

MOS

Rank

Unit

Commanding Officer or By Direction Authority

Name

Phone Number

Email