Certified Nursing Assistant

Do you enjoy helping others? Are you looking for a career with many rewards? If so, then this might be the career change for you. After 90 hours of classroom theory and 90 hours of clinical and laboratory work, hands-on at a local long-term care facilities, and final exam, you will be State of Maine certified.

Requirements:

  • Proof of age (at least 16)
  • Proof of high school graduation or equivalency
  • Completed and signed application form
  • Two (2) letters of recommendation
  • Be in good physical and mental health
  • Be dependable, reliable and have good work habits
  • Successful completion of a reading entrance exam (Reading CASAS score of 236 or higher), intake paperwork and completed interview
  • MANDATORY MEETING: Tuesday, OCTOBER 11, 2016
  • 3pm at Skowhegan Area High School Adult Education
  • $300 deposit or proof of third-party payment required with your application
  • Full payment is due prior to first class.

Class and Clinical dates and time will be at Mount Saint Joseph in Waterville

Classes begin Tuesday, October 18, 2016, and end December 27, 2016

State Exam will be at SAHS on Wednesday, December 28, 2016

Graduation will be at MSJ on Thursday, December 29, 2016

Space is limited so please contact the Adult Education Office for an application.

Tuition: $1,000.00


RSU 54 Adult & Community Education

CERTIFIED NURSING ASSISTANT COURSE APPLICATION

Contact Information

NAME______SS #______

ADDRESS: ______

Phone: ______Email:______

Education

Do you hold a high school diploma ____ or High School Equivalency Diploma ____

Name and address of high school:

Name and address of post secondary education and highest degree acquired:

Employment History (start with most recent, and the last 10 years)

EMPLOYER_ADDRESS ______

CONTACT PERSON PHONE ______

REASON FOR LEAVINGDATES WORKED ______

EMPLOYER ADDRESS ______

CONTACT PERSON PHONE ______

REASON FOR LEAVINGDATES WORKED ______

ATTACH ANOTHER SHEET IF MORE ROOM IS NEEDED FOR EMPLOYMENT HISTORY

PERSONAL REFERENCES: Name, Address and Telephone

(Attach two letters of reference with your application.)

1.______

2.______

Criminal Background Check

Please answer the following questions:

  1. Have you ever been denied a nursing assistant certificate/license?

Yes______No______

  1. Have you ever had any disciplinary action (probation, suspension, revocation or reprimand) taken against your nursing assistant certificate/license?

Yes______No______

  1. Have you ever been convicted of any crime under the laws of Maine?

Yes______No______

  1. Have you ever appeared in any court, paid any fine or been put on probation?

Yes______No______

  1. Have you ever been convicted of any crime under the laws of any other state?

Yes______No______

  1. Have you ever been convicted of any crime under the Federal law of the United States?

Yes______No______

Below, please comment if you answered yes to any of the above questions 1-6. If you have answered “yes” to questions 1 or 2 above, you must attach an explanatory letter with the location, and date of each occurrence. If you have answered “yes” to questions 3, 4, 5 or 6, please attach court documents pertaining to each conviction. If you are not sure if you have been convicted of a crime, you must attach an explanatory letter.

  • I wish to be considered as an applicant for the Certified Nursing Assistant Program at RSU 54 Adult Education & Mount Saint Joseph, Waterville, Maine. I have provided proof of educational transcripts to you.
  • I have read and understand the admission qualifications for this program. If accepted, I agree to abide by the rules and regulations of the program. I understand my references will be checked.
  • Two (2) letters of Recommendation
  • Failure to furnish all information on education, employment and personal background may constitute adequate reason for disqualification of my application or subsequent dismissal from this program.
  • My signature below also gives you permission to conduct an SBI check. I understand that I cannot participate in the clinical experience until the SBI check has been returned to you.
  • I am at least 16 years old (copy of birth certificate provided).
  • I am in good physical and mental health.
  • I do not abuse alcohol or drugs.
  • I am dependable, reliable, and have good work habits.
  • Applications must be returned to the office by October 11, 2016!

Falsification of information on this application is reason for dismissal.

Signature______Date______

Please print name ______

A State Bureau of Identification (SBI) check will be initiated by this application process. Upon successful completion of this program, the results of this SBI check will be forwarded to the State of Maine Registry for Certified Nursing Assistants along with the certificate and application.

Interview Questions: Be prepared to answer these (and other) questions at your interview.

  1. What does a CNA do in his/her job?
  1. Why do you want to work as a CNA?
  1. Do you understand that you will spend several hours of this program doing hands on work with the elderly and/or ill persons?
  1. Have you had any experience working with the elderly and/or ill persons? If yes, when and where?

Interviewer Signature______

Date: ______

Instructor Signature______

BACKGROUND CHECK WAIVER

It is the policy of RSU54 to conduct criminal background checks on all potential employees/volunteers. Employment/volunteering in RSU54 is contingent on the results of such checks. In order to conduct the check, a birthdate is required. Please provide us with your birthdate, sign the waiver, and return it to us.

Full Name: ______Birthdate: ______

Any other name used (including maiden name): ______

Current Address: ______

______

I understand that the above information I have voluntarily provided will be used solely for the purpose of a background check. It will not be used for any other reason until such time as I become an RSU54 employee/volunteer.

______

SignatureDate

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