Warehouseman Training Inc

Pre-Registration for
Warehouseman Training Classes


  Last Name
  First Name
  Mid.Int


  Last Four SSN


  Email
  Alt.Email


  Address
  Apt #


  City
  State
  Zip


  Home Phone
  Cell Phone


  Alt.Contact
  Alt.Phone


  Gender
Female    Male    Undisclosed


On Parole or Probation:
Yes    No



Following Questions to determine Sponsor (funding)


Veteran:
Yes    No


Youth (17-24):
Yes    No


Dislocated Worker:
Yes    No


Drug and Alcohol Treatment:
Yes    No


Non-Custodial Parent:
Yes    No


Recieving Food Stamps:
Yes    No


Recieving Unemployment:
Yes    No


Own a Vehicle:
Yes    No


Education:
HS Diploma    GED/HiSet


Have you ever worked with Vocational Rehab (VR):
Yes    No


How did you hear about the Program / Comments