APPLICATION FOR ENROLLMENT

Phone 830-885-5948, Fax: 830-885-5949 e-mail:wwk9@gvtc.com

Please print and fill out the application form completely and mail along with application fee of $100.00. This application fee is nonrefundable.

Please check the programs you would like to attend:

__ Trainer Program
__ Professional Trainer Program
__ Master Trainer Program
__ Police Trainer Program


(Please Print)

What date would you like to begin training? _________________

Would you like to stay at our facilities? ___________________

Name___________________________________________________________

Address _______________________________________________________

City__________________________ State_______ Zip____________

Area code and phone ___________________ Age _________ Birth date__________

Social Security number ________________ Birth Place _______________________

Drivers license number _______________________________

Marital Status _________________

Physical condition and health_______________________________________________

Do you qualify for Vocational Rehabilitation? If you think so then please list physical disabilities: ______________________________________________________

It is important that you provide all possible information pertaining to employment in the last 5 years. Include an extra sheet of paper if more room is needed.

Present:
Occupation_______________________Supervisor________________Phone___________
Dates employed _____________ Type of work performed___________________________
Previous:
Occupation_______________________Supervisor________________Phone___________
Dates employed _____________ Type of work performed __________________________
Next previous:
Occupation_______________________Supervisor________________Phone___________
Dates employed _____________ Type of work performed ___________________________

Do we have your permission to check your local, state, and federal credit and security information?
YES ___ NO ___.




Have you attended any other training schools? YES NO If yes please briefly explain:
_____________________________________________________________________________

Name, location and phone number of high school attended
_____________________________________________________________________________
Date Graduated?__________

Name, location and phone number of College attended
________________________________________________________________________________
Date Graduated?________

Please list experience you have working with animals. (Include extra sheet of paper if needed)

 

 

 

 

Trained level (if any) and breeds of dogs presently owned.
________________________________________________________________
________________________________________________________________
________________________________________________________________

Please list three personal references with all information requested.

Reference 1:
Name:_____________________________________________
Address:__________________________________________
City, State, Zip:_________________________________
Phone Number:_____________________________________
Relationship:_____________________________________

Reference 2:
Name:_____________________________________________
Address:__________________________________________
City, State, Zip:_________________________________
Phone Number:_____________________________________
Relationship:_____________________________________

Reference 3:
Name:_____________________________________________
Address:__________________________________________
City, State, Zip:_________________________________
Phone Number:_____________________________________
Relationship:_____________________________________

On another sheet please include a brief explanation of your interests, and future goals.

We the undersigned have read and understand the terms of the above (Catalog/Enrollment Agreement) and agree to be bound by them.

Agent of Worldwide Canine, Inc. ______________________Date_____________

Student____________________________________Date______________________