General Motors Automotive Service Educational Program (GM ASEP)

* fields are required

Personal Information

First name: *

Middle initial:

Last name: *

Address: *

City: *

State: *

Zip code: *

Cell phone: *

Email: *

Birth Year: *

S-number:

Education

List your educational background beginning with the most current.

School/College Degree/Diploma: *

Location: *

Dates attended: *

Did you graduate?: *

YesNo

School/College Degree/Diploma:

Location:

Dates attended:

Did you graduate?:

YesNo

School/College Degree/Diploma:

Location:

Dates attended:

Did you graduate?:

YesNo

Formal Automotive Training

Did you attend a high school automotive program?: *

YesNo

Indicate high school or career center attended: *

Graduation year: *

Qualities

List your strengths that make you a good candidates for a GM dealership.: *

List your weaknesses that you want to improve upon to make you a better candidate for a GM dealership.: *

Work Experience

List your work experience beginning with the most current.

Employer:

Location:

Supervisor:

Phone:

Dates of employment:

Duties:

Employer:

Location:

Supervisor:

Phone:

Dates of employment:

Statement

I hereby state that the information given above is true and correct. I understand that if I knowingly provided incorrect or false information that I may forfeit the opportunity to be selected as a participant in the GM ASEP Program.

In addition, I hereby authorize Cuyahoga Community College to release any placement test scores, final grades, college transcripts, and/or academic information, if requested, to the sponsoring GM dealership. I also hereby authorize the release of placement test scores, college transcripts and/or academic information to Cuyahoga Community College employees and/or any agency or private business for educational, scholarship, or employment purposes only.

Acknowledgment: *

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