Registration Form - English 2023
Registration
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First Name and Last Name (Complete) *
Phone Number
*
E-Mail
*
Address, City, State and Zip Code
*
Nationality
*
Sex
Clear selection
Birthdate
*
MM
/
DD
/
YYYY
Education *
Required
Employer (If you do not have an employer, please enter your complete information)
*
Employer Address (Address, City, State, Zip Code)
*
Employer Phone Number
*
Date of Hire (If you do not have a contract date, please enter your date of birth)
*
MM
/
DD
/
YYYY
ASE Certification *
Required
ASE Medium and Heavy Truck *
Required
ASE Collision and Refinishing *
Required
16 Miami-Dade County Continuing Education Hours *
Required
20 hours of continuing education from Miami-Dade County *
Required
32 Miami-Dade County Continuing Education Hours *
Required
Electronic Professional Automotive Training (6 months) *
Required
Submit
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