Honda PACT Supplemental Application Applicant InformationName* First Middle Last Date of Birth MM slash DD slash YYYY RHC Student ID*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneHome PhoneEmail* Are you over 18 years of age?* YES NO Are you a U.S. Veteran? YES NO EducationHigh school attended?CityYear of HS Graduation or GED completionPlease list the automotive/transportation related courses you have completed:Course NameCollege/High SchoolName of instructor/teacherWhenGrade If you have not completed any courses, please add N/A on the first column. Click the plus sign (+) to add more entries (up to 10 rows). Honda PACT Related QuestionsStudents may be offered the opportunity to work at local dealerships. In order to participate you will need to provide documentation of your eligibility to work. Do you have a valid driver’s license?Note: You will need to provide a copy of your driving record YES NO Do you have any points on your driving record? YES NO Please state how many pointsDo you have your own transportation? YES NO Have you ever had automotive training before? YES NO Please enter Automotive Training's information High School ROP Military Other Please specify other locationPlease explain about your automotive trainingI understand that the Honda PACT program will attempt to place me in a dealership that is relative close to Rio Hondo College. In certain cases I understand that is not possible, therefore placement in a work experience site maybe at dealership that is between 10 miles to 15 miles from Rio Hondo College.* AGREE DISAGREE Honda conducts background checks; is there any reason you may not be considered for employment?* YES NO NOT SURE Work Experience*LIST THE MOST RECENT/CURRENT WITHIN THE PAST TWO YEARSAre you currently employed by an Acura or a Honda Dealership? YES NO Please provide the following information:Name of DealershipLocationName of supervisorDates of EmploymentDutiesDo you have automotive related work experience? YES NO Please provide the following information:Name of EmployerLocationName of supervisorDates of EmploymentDutiesAre you currently employed? YES NO Please provide the following information:Name of EmployerLocationName of supervisorDates of EmploymentDutiesApplicant’s Signaturere-Enter your full name and today’s date as your signature Full Name*Today's Date* MM slash DD slash YYYY How did you find out about the P.A.C.T. Program?
