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    Please answer the following Questions honestly

    1. Are you at least 21 years of age?

    2. Have you held a regular drivers license for at least one year?

    3. Do you have a valid Michigan Drivers License?

    4. Do you have a high school diploma or GED equivalent?

    5. Have you ever driven a manual (stick shift) transmission?

    6. Do you have any experience with backing up/hauling trailers behind your vehicle (including boats, campers, flatbeds, etc.)?

    7. How many jobs have you held in the last five years?

    8. How many moving violations do you have in the last 3 years?

    9. How many accidents have you been involved in the last 10 years?

    10. Are you currently?

    11. Are you a military veteran?

    12. Do you have access to your Birth Certificate?

    If you answer YES to questions 13-29 please explain below

    13. Have you been unemployed for a period greater than 6 months?

    14. Have you ever been convicted of a felony?

    15. Have you ever been convicted of a misdemeanor?

    16. Have you ever been or are you currently on parole or probation?

    17. Have you ever had your license suspended?

    18. Have you ever been convicted of careless or reckless driving?

    19. Have you ever been convicted of a DUI, OUIL, MIP, etc.?

    20. Have you ever had a positive drug or alcohol screen?

    21. Are you an insulin injection dependent diabetic?

    22. Do you have Epilepsy?

    23. Do you have high blood pressure?

    24. Do you have any vision problems?

    25. Do you have any hearing problems?

    26. Do you have a lifting restriction?

    27. Do you have a sleep disorder? (Sleep Apnea)

    28. Are you currently under a Doctors care?

    29. Are you currently taking prescription drugs?

    If you answered yes to questions 13-29 please explain below and list dates if applicable?

    Type your name and date below if you agree your answers are factual to the best of your


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