* 1. Please enter your full name:

* 2. Contact Phone Number with Area Code:

* 3. Contact Email Address:

* 4. Who referred you to this training?

* 5. Which Career Field Interests You?

* 6. Do you have a High School Diploma or GED?

* 7. Please answer the following Questions by checking the boxes in the YES or NO columns:

Are you 18 years old or older?
Do you have a VALID Driver's License?
Are you able to attend the class Monday through Friday from 7:00 a.m. to 3:30 p.m.?
Do you have reliable transportation to the course?
Will you be able to obtain safety shoes for the course?
Will you be able to obtain leather safety gloves for the course?

* 8. The physical requirements of training for the ship repair industry may include: using respirator equipment, lifting, kneeling, squatting, climbing, working in confined spaces, working in extreme temperatures, etc.

Is there anything that might hinder your ability to perform the physical requirements of this trades training?

* 9. Ship repairers must meet a certain standard of conduct to obtain security passes in order to work in the shipyards. The following questions indicate a MINIMUM level of conduct that is required, and

If you took a drug test today, are you confident you would pass it?