Application oak-manor-sponsorship-pp21

First Name *

Last Name *

Phone Number *

Email Address *

What city do you live in? *

What zip code do you live in? *

All candidates that apply will be required to do a mandatory drug screening, would you be able to successfully pass a drug screening? *

Yes
No – If you select no, please don’t continue forward with submission of this application.

Do you have a High School Diploma or GED? *

Yes
No

Are you looking for Full-time work (with benefits) or Part-time? *

Part-time – 29 Hours or Less weekly
Full-time – 30 to 40 Hours weekly

Are you available to work Weekends? *

Yes – I am available for weekends.
No – I can’t work weekends at all.
I can work every other weekend

What shifts are you available (check all that apply)? *

7AM to 3PM
3PM to 11PM
11PM to 7AM

Are you currently working now? *

Yes
No

If Yes, why are you looking to change jobs?

Have you ever worked in any healthcare related field previously? *

Yes
No

Do you have reliable transportation? Which of the following statements best answer this question? *

Yes, I have my own car
Yes, I have a reliable friend or relative to transport me to and from work.
Yes, I take the bus.
No, I don’t have transportation.

Childcare can be an obstacle for many candidates when training and/or working afternoon or evening shifts. We want to be able to find the right employment situation for your needs. Do you have reliable childcare so that are able to work 3PM to 11PM or 11PM to 7AM? *

Yes, I have reliable childcare
No, I would need daytime hours to coordinate with my childcare arrangements.
My children are old enough to not need childcare
I don’t have children

A skilled nursing facilities operate 24/7 to provide care to residents. This means that you may have to work some holidays (i.e. Christmas, New Year’s, Thankgiving, etc). Are you willing to work holidays? *

Yes
No

Have you ever been arrested by the police or law enforcement before (fingerprinted)? *

Yes
No

If yes please explain

In your lifetime, have you ever been required to complete community service hours or been on probation? *

Yes
No

If yes, please explain

Have you ever been convicted or pled guilty to any type of felony or misdemeanor? *

Yes
No

If yes, please explain

Have you ever applied and received an Criminal Background Exemption for Healthcare or State employment in the past? *

Yes
No

If an employer were willing to sponsor your CNA Training tuition, exam fees, and Level II screening fees, would you be willing to commit to a three-month working agreement? *

Yes
No

Application

Please be sure you hit SUBMIT button at above after completing.

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