HVAC

Technical Academy

Enrollment Form

Gainfull Employment

By submitting this form I give full permission to allow representatives from 2nd Chance University, CareerSource Central Florida, and HVAC Technical Academy to assist in my career progression upon program completion. Permission includes assistance in career document preparation, presentation, and contacting potential employees (in written, digital, and phone). I also give permission to follow up over the next 24 months with current employers for gainful employment purposes.

Gainfull Employment

By signing I acknowlwedge the submitted information is true and accurate. I agree to allow HVACTA (or a representative from CareerSource Central Florida, or 2nd Chance University) to contact me for additional information and/or clarification. I also agree to schedule an on-site interview prior to acceptance. In addition, I understand submitting this application is not an automatic acceptance into the program.

First Name

Last Name

Middle Initial

Date

Street Address

Apartment / Unit #

State

Zipcode

Primary Phone

Secondary Phone

Email Address

In case Of Emergency Contact

Relationship

City

Phone

Term Applying For (month and year)

Are you a citizen of the United States

Are you Eligible to work in the U.S.

Do you have a drivers license

Explain if you have marks or have been revoked on your drivers licence?

Have you ever been convicted of a felony?

If yes, are you on parole or probation?

If yes, explain:

If on probation or parole where do you report

If you are on probation or parole to whom do you report to?

If on probation or parole what is officers contact phone number?

If yes and for the purposes of career management, are there any circumstances which a potential employer may find hiring you difficult; please explain:

If yes, are there stipulations which may cause you to miss class attendance or employment upon graduation?

Are you able to climb a 12 foot ladder:

Are you able to crawl beneath a mobile home:

Are you able to enter an attic and perform attic work:

Are you afraid of heights:

Can you lift 45 pounds:

Are you able to stand without support for 45 minutes or longer:

Are there any medical conditions which may impair your ability to perform efficiently and safely?

If yes, please explain the medical condition:

Referred to HVAC Technical Academy by:

Are you a US military veteran?

Funding Source:

Do you have transportation to attend class?

If no, how do you plan on attending classes five days a week over a six week program?