DPTS Input Form



Dealer Personnel Tracking System (DPTS)

Application Form

|How did you hear of Honda’s training? |Weber State University - Automotive Technology |

All fields must be completed in order to receive access to Honda’s Interactive Network.

Incomplete forms will be returned and access delayed.

|Type of Applicant: | |PACT Student | |PACT Instructor |Other: |      |

|APPLICANT PERSONAL INFORMATION: |Social Security Number: |    -    -      |

|Last Name: |      |First Name: |     |Middle Initial: |  |

|Birth Date: |  -   -     |Home Address: |      |

|City: |      |State: |   |Zip Code: |      |

|Telephone: |    -     -      |Ext. |      |Email Address: |      |

|T-Shirt Size: |SM / M / L / XL / XXL or XXL: |      |*If an adjunct instructor, contract end date is: |  -    -      |

|SCHOOL INFORMATION: |School Name: |Weber State University |

|School Address: |1504 University Circle |

| |Ogden, Utah 84408-1504 |

|DEALER INFORMATION: |If working at a dealer, initial employment date : |   -    -      |

|DPTS Number: |      |Dealer Number: |      |Dealer Name: |      |

Related Training Experience: (select all that apply) Educational Background: (select highest completed)

01 High School 02 Community College 01 Less than 02 High School

High School Diploma

03 Apprenticeship 04 4-year College

03 College 04 Associate's

05 Military 06 Private School Coursework Degree

07 Other Company Schools 08 Other 05 Bachelor's 06 Graduate

Degree Coursework

Access to Honda’s proprietary training and technical publications is provided to you solely for the purpose of supporting your school’s request for Honda technical training and service information for educational purposes only. By selecting the box below, you agree that you will not infringe upon Honda’s copyrights and will not at any time or under any circumstances share or divulge Honda’s materials, the password(s) and/or log in information. You agree to access Honda’s training materials and publications solely for educational purposes at the school listed at the top of this document and for no other reason.

By selecting this box, the applicant named on this document agrees to adhere to the terms and conditions in lieu of their signature.

Please return this completed form to your PACT Coordinator.

PACT Coordinator use only:

|Above Student has completed the Express Service Certification: |Yes / No |Date Sent: |      |

Industry Education use only:

|DPTS #: |      |Dealer #: |      |User ID: |      |Password: |      |

| | |Dealer #: |      |User ID: |      |Password: |      |

|Welcome Package Sent to Program Coordinator: |Yes / No |Date Sent: |      |

Updated: 8/23/2010

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download