ACTS CAS Training Application

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Panel Building
Cerarmix Products
Opportunities

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First Name:*

Last Name:*

Email:*

City of Residence:*

State of Residence:*

Are you enrolling as part of a Company/Organization or as an Individual?* Company/Organization Individual

Company Name:*

What is the highest level of education you have completed?*

Number of Years Attended College:*

College degrees achieved:* Associates Degree
Bachelors Degree
Masters Degree
PHD/Doctorate
None

Do you have a Driver's License?* Yes
No

Do you have a valid Commercial Driver's License (CDL)?* Yes
No

If Yes, What State?*

Are you currently employed?* Yes
No

Do you speak and comprehend a second Language?* Yes
No

If Yes, What language would you consider your second language?*

Do you have basic Math skills such as Addition, Substraction, Division, Multiplication or Percentages?* Yes
No

Do you possess any OSHA certifications?* Yes
No

If you do, Identify which OSHA certifications you have achieved:* Scaffolding
Flagging
Welding
Crane, Derrick, Hoist
Forklift
10 Hr Construction
Ladder Safety
Respiratory Protection
30 Hr Construction
30 Hr General Industry
40 Hr Oil Industry
16 Hr Disaster Site Worker
Confined Spaces

Do you have a working knowledge of a personal computer?* Yes
No

Which operating systems do you have a working knowledge of? PC/Windows
Mac/OS
Linux
Android

Do you have access to a personal computer?* Yes
No

Do you have access to a computer laptop or tablet?* Yes
No

Do you consider yourself mechanically inclined?* Yes
No

Do you have experience working with basic hand tools?* Yes
No

Do you have experience working with power tools?* Yes
No

Do you have experience working with pneumatic/air driven tools?* Yes
No

Do you have experience working with chemicals?* Yes
No

Are you currently in the Armed Forces?* Yes
No

Have you ever been in the Armed Forces?* Yes
No

Have you ever been convicted of a Felony?* Yes
No

I agree to the ACTS CSI Covenant

I agree to the ACTS CSI Training Policy

I agree to the ACTS CSI Photo/Media Release

Thank You! Your Application has been sent!

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