2. CDL Training Request Form
4. First Name*
5. Last Name*
7. Address1*
9. City*
10. State*
    -- Select One --MDPAWVVADE
11. Zip*
13. Date of Birth*
    Date of Birth
14. Phone Number*
15. Frederick County Email Address*
19. What Class is your current license?*

    1. Class A
    2. Class B
    3. Class C
20. Is your Current License*

    1. Commercial
    2. Non- Commercial
22. License type desired*

    1. Class A
    2. Class B
24. Which Division of Frederick County do you work for?*

    This answer will submit email to the approval authority, from you division ,for your training.

    1. DFRS - Chad Johns
    2. City of Frederick - Jeana Panarella
    3. Highway Operations - Gary Ruble
    4. Landfill - Nickolas Root
    5. Parks & Rec - Jason Jenkins
    6. Transit - Bob Dinsmore
    7. Water & Sewer - Joe Romagnoli
28. I agree to submit to my division documentation regarding my successful completion of this course. I further agree to abide by the Travel Regulations and Expense Report procedures detailed in Section IV of the Frederick County Purchasing Rules & Regulations, if applicable.*

    I further agree to submit a front and back copy of my State issued Drivers License to CDLTraining@Frederickcountymd.gov

    1. Checking box is equivalent to my electronic signature.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field