Service Oiler 320 Hours / M304


Subject to $25 Application Fee
Personal Information
First Name:
Middle Name (N/A if not applicable):
Last Name:
Date of Birth:
SSN:
Sex:
Alaska Driver's License / State ID (N/A if not applicable):
State ID Location:
Race:
Other (N/A if not applicable):
Mailing Address
Address 1:
Address 2 (N/A if not applicable):
City:
State:
Zip Code:
Email:
Home Phone:
Mobile Phone:
Emergency Contact Information
Name:
Address 1:
Address 2 (N/A if not applicable):
City:
State:
Zip Code:
Home Phone:
Work Phone (N/A if not applicable):
Housing Information
I will be living at:
Address (N/A if not applicable):
City:
State:
Zip Code:
Employment Status /Experience
Current Status
Employment Status:
Employment Schedule (N/A if not applicable):
Benefits:
Employer's Name (N/A if not applicable):
Employer's Supervisor (N/A if not applicable):
Employer's Phone (N/A if not applicable):
Date of Employment (N/A if not applicable):
Length of Employment (N/A if not applicable):
Veteran Status
Veteran Status (N/A if not applicable):
Branch of Service (N/A if not applicable):
Benefits Available (N/A if not applicable):
Employment Goals
Employers I am interested in:
#1 Employer of interest (N/A if not applicable):
#1 Position of interest (N/A if not applicable):
#2 Employer of interest (N/A if not applicable):
#2 Position of interest (N/A if not applicable):
#3 Employer of interest (N/A if not applicable):
#3 Position of interest (N/A if not applicable):
Please describe what job or jobs you would like to be employed in after completing this training (N/A if not applicable):
Funding Information
Please indicate how you intend to pay for your training (tuition, fees, books, tools, supplies, room and board). It is highly recommended that you apply for grants and scholarships to help fund your training.
Do you intend to pay for training and living expenses with Personal Funds?
If yes, please list the status of the Alaska Student Loans(s) that you have applied for (N/A if not applicable):
Do you intend to pay for training and living expenses with Scholarships?
Do you intend to pay for training and living expenses with Alaska Native Scholarships?
If yes, please list the Alaska Native Scholarship(s) where you have applied (N/A if not applicable):
Do you intend to pay for training and living expenses with Veteran's Benefits?
Do you intend to pay for training and living expenses with State of Alaska Grants?
#1 Agency providing financial aid, if applicable
Agency Name (N/A if not applicable):
Agency Phone (N/A if not applicable):
Contact Name (N/A if not applicable):
Contact Email (N/A if not applicable):
#2 Agency providing financial aid, if applicable
Agency Name (N/A if not applicable):
Agency Phone (N/A if not applicable):
Contact Name (N/A if not applicable):
Contact Email (N/A if not applicable):
Educational Background
Education Level (N/A if not applicable):
High School Attended (N/A if not applicable):
City and State of High School (N/A if not applicable):
Month/Year Graduated from High School (N/A if not applicable):
Or: GED State Issued (N/A if not applicable)
GED Year Issued (N/A if not applicable):
Post-Secondary Attendance, Please List Name and Dates Attended (N/A if not applicable):
Health Questionnaire
Vision Impairments?
Eye Loss?
Color Blindness?
High Blood Pressure?
Difficulty Hearing?
Epilepsy?
Limb Loss?
Diabetis?
Heart Problems?
Back or Knee Injuries?
I understand that I may be required to lift up to 50 pounds. Training may require constant bending, twisting, stooping, lifting, climbing of stairs or hills, and sitting or standing for extended periods of time, in all types of weather.
Enter Initials (N/A if not applicable):
Personal Plans
Please describe your personal plans upon training completion (N/A if not applicable):
Statement of Correctness, Understanding, Authorization and Privacy Act Waiver
I have read and understood all NIT Admission and Training Policies. (viewable at www.nitalaska.com)
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I understand that my program may require a drug screen and physical exam. I understand that these are mandatory to participate in that program
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I understand and consent that if enrolled; I will be placed in a random drug testing database and could be called at any time for a retest. I understand that if I fail a drug test, at any time, I will be released from training
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I understand that there are physical demands of working in Alaska. I have suitable outdoor work gear such as work boots, warm jacket, pants, coat, hat, etc.
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I understand Northern Industrial Training, LLC courses that are less than 80 hours and testing fees are non-refundable. For courses 80 hours or longer, the student enrollment contract (refund policy) applies.
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Do you have any outstanding or unpaid traffic fines or citations in any states?
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I hereby attest that all the information I have provided to Northern Industrial Training, LLC is true, correct, and complete. I understand I have submitted this information as being true and accurate; realizing that approval or disapproval of my enrollment will be based on this application and that any misrepresentation or omission of information called for is cause for rejection. Further, I clearly understand that school acceptance of my enrollment will be based on this application and the information contained herein.
Enter Initials