Apply for Certified Nurse Assistant (CNA)

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Certified Nurse Assistant (CNA)
ID:LHS-141
Location:Braco, NC
Department:Certified Nurse Assistant (CNA)
Pay Range:$15 - $25
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Contact Information
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Address 2:
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Application for Employment
EMPLOYMENT APPLICATION
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PROFESSIONAL LICENSURE
EMERGENCY CONTACT INFORMATION

We would like to have the names of two (2) contacts that we could call in the case of emergency. Please provide that information below for our files and reference.


Special Instructions

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Yes   No
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APPLICANT DECLARATION
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EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

High School

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College

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Specialty

(Please list most current experience first)

EMPLOYMENT HISTORY

Give your full employment record, starting with your current or most recent employment

Employer 1

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Employer 2

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Employer 3

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Employer 4

Yes   No

Employer 5

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REFERENCES

Please provide three references (not relatives).

Reference 1

Reference 2

Reference 3
AUTHORIZATION

The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.


I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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