Information for the Class Of

INFORMATION FOR THE CLASS OF 2018-2019

Huntsville Memorial Hospital's Joe G. Davis School of Vocational Nursing is approved by the Texas Board of Nursing and the Texas Education Agency

The program is a twelve (12) month consecutive program.

The program consists of classroom, laboratory, and clinical experiences. In addition to Huntsville Memorial Hospital, other health care facilities in the area are used for clinical rotations.

A diploma is issued upon satisfactory completion of all program requirements. Graduates of the program are eligible to take the State Board Licensing Examination known as the NCLEX.

More information concerning eligibility may be obtained at

The graduate is not considered to be a Licensed Vocational Nurse (LVN) until successfully passing the BON Jurisprudence and State Board Licensing Examination.

ALL STUDENTS MUST COMPLETE FBI FINGERPRINTING AND TEXAS BOARD OF NURSING BACKGROUNG CHECK CLEARANCE BEFORE ATTENDING SCHOOL *NO EXCEPTIONS*

BEGINNING THE PROCESS

Submit your fully completed/signed application with Official GED scores/high school/college transcripts/Licenses to Joe G. Davis School by mail or in person. All applications must be in possession of the school beginning March 20, 2017 to July 31, 2017.

PRE-ENTRANCE EXAMINATION

Test can be scheduledas soon as your fully completed/signed application and official transcripts/licenses are verified as received by the school.

AT LEAST (10) DAYS BEFORE TESTING:

Potential students must phone SHSU in advance to schedule time and pay. Their appointment to test will not be set until payment is received. If they fail to arrive for the scheduled test, they will be required to pay an additional $50.00.

Please call SHSU at 936-294-1025 for cost of testing.

After Submission:

• Test location – Sam Houston State University testing center.
• Center is open Monday – Friday testing times are 8am to 11am.
• If you choose to retake the test, the last test taken is the score that will be used by the school, but all scores must be submitted.
• All testers must bring a picture ID.
• All students must submit test scores to the school on the day you are tested.

INTERVIEW REQUIREMENTS

• Official GED/high school transcript/ college transcripts/Licensures.
• Good physical and mental health
• Picture ID (ex: Driver’s License)
• Completed application and any additional requested paperwork at time of interview.

• Satisfactory score on the school’s pre-entrance examination.
• At least four (4) personal references. No relatives or extended family members will be accepted.
• At least three (3) work references if you have ever been employed. (If you have less than 3, submit 2 additional personal references).

• Proof of starting the Hepatitis B Vaccine Series. A titer will be required for selected applicants prior to attending class.
• Proof of all vaccines (TB, MMR, TD, Flu, Chicken Pox and Hepatitis B series).

TUITION AND FEES:

The tuition is (TBD) for the year and must be paid in full no later than (2) weeks before the first day of school.

Estimated additional costs (Books, uniforms, etc.) could range up to $2500.00 depending on non-affiliated vendor cost.

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

Mail completed applications to:

Joe G. Davis School of Vocational Nursing

P O Box 4001 Huntsville, Texas

77342-4001

Telephone: 936.291.4545

Applications will be accepted for processing in April, May and June, & July 2017

Classroom facilities are located at:

521 I-45 South, Suite 8, Huntsville, TX.

Application reviewed by the Advisory Committee

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STUDENT APPLICATION FOR CLASS OF 2018-2019

Joe G. Davis School of Vocational Nursing
HUNTSVILLE MEMORIAL HOSPITAL
P.O. Box 4001
Huntsville, Texas 77342-4001
(936) 291-4545 /

SCHOOL USE ONLY

Test: ______
Test: ______
Joe G. Davis School of Vocational Nursing is an equal opportunity institution and complies with all federal and Texas laws, regarding affirmative action requirements in all programs and policies. In compliance with Title VII of the Civil Rights Act of 1964, as amended by the Equal Opportunity Act of 1972, and Section 504 of the Rehabilitation Act of 1973, and the Older Americans Amendment of 1975, this institution does not discriminate on the basis of age, race, color, religion, sex, national origin, or disability in administration of its education policies, admissions policies, scholarship programs, and other school administered programs

PLEASE PRINT ALL INFORMATION

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

Last Name / First Name / Middle Name / Maiden Name
Mailing Address / Street Address (If different from Mailing Address) / City / State Zip Code
Home Phone / Cell Phone / Work Phone / Email Address
Social Security Number / Date of Birth / Texas Drivers License/ID Number / Alternate Email Address

PERSONAL INFORMATION

Do you have any business, social/family obligations or medical conditions that would prevent you from attending school consistently if you are accepted?  Yes  No If Yes, please explain below.
______
Are you either a U.S. Citizen or an alien who has the legal right to attend school in the U.S.A. ? Yes No
If no, are you considered a permanent resident? Yes  No Card #______
Are you a former student of the Joe G. Davis School of Vocational Nursing?  Yes  No
If "Yes", year enrolled ______
Have you previously applied for enrollment in this school?  Yes  No Year:______/ FOR SCHOOL USE ONLY
Date Received:

EDUCATION AND TRAINING

The applicant is to furnish the School of Vocational Nursing original transcripts from each of the listed educational facilities. If applicable, a photocopy of the GED report showing test scores must be furnished to the School.

NAME OF INSTITUTION

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COURSE OF STUDY

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LAST YEAR COMPLETED

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DID YOU

GRADUATE?

/ MONTH/YEAR
GRADUATED
(High School – City/State) / 9 10 11 12 / YES NO
GED(State Obtained)
(College) / 1 2 3 4 / YES NO
(Vocational/Tech School) / 1 2 3 4 / YES NO

Please answer the following questions:

1)  No  Yes / For any criminal offense, including those pending appeal, have you: A) been convicted of a misdemeanor? B) been convicted of a felony? C) pled nolo contendere, no contest, or guilty? D) received deferred adjudication? E) been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? F) been sentenced to serve jail or prison time? court-ordered confinement? G) been granted pre-trial diversion? H) been arrested or any pending criminal charges? I) been cited or charged with any violation of the law? J) been subject of a court-martial; Article 15 violation; or received any form of military judgment/punishment/action? (You may only exclude Class C misdemeanor traffic violations.)
2)  No  Yes / Do you have any criminal charges pending, including unresolved arrests?
3)  No  Yes / Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a professional license or certificate held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you?
4)  No  Yes / Within the past five (5) years have you been addicted to and/or treated for the use of alcohol or any other drug?
5)  No  Yes / Within the past five (5) years have you been diagnosed with, treated, or hospitalized for schizophrenia and/or psychotic disorder, bipolar disorder, paranoid personality disorder, antisocial personality disorder, or borderline personality disorder?  Yes  No
If “YES”, indicate the condition:  schizophrenia and/or psychotic disorders, bipolar disorder,  paranoid personality disorder,
 antisocial personality disorder,  borderline personality disorder

All students must have full clearance with the Texas Board of Nursing prior to attending nursing school.

The questions above may determine your eligibility to attend nursing school and to become licensed.

For more information on eligibility please contact the Texas Board of Nursing at (512)305-7400.

EMPLOYMENT HISTORY
Beginning with most recent employment, please provide COMPLETE CURRENT MAILING ADDRESSES FOR EACH PLACE OF EMPLOYMENT LISTED INCLUDINGZIP CODES and CORRECT employment dates. Do not list self-employment or those that no longer are in business. List only employments that can be verified. Incorrect information/omitted information may delay or cause your application not to be processed for final review.
Incomplete information may result in applicant not being able to register to test or attend school.
PLEASE NOTE: IF LESS THAN THREE (3) WORK REFERENCES PLEASE PROVIDE TWO (2) ADDITIONAL PERSONAL REFERENCES
PLEASE PRINT LEGIBLY
Company Name / Mailing Address
Phone Number / City / State / Zip Code
Position Held / Supervisors Name / Phone Number
Your name if different from current / Start Date End Date / Reason for leaving
Company Name / Mailing Address
Phone Number / City / State / Zip Code
Position Held / Supervisors Name / Phone Number
Your name if different from current / Start Date End Date / Reason for leaving
Company Name / Mailing Address
Phone Number / City / State / Zip Code
Position Held / Supervisors Name / Phone Number
Your name if different from current / Start Date End Date / Reason for leaving

COMPLETE MAILING ADDRESSES on your work and personal references are required. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

Personal references - do not list relatives or employers. Use counselors, teachers, coworkers, church members, etc. Do Not list as personal references the same persons listed as supervisors in your employment history. Incorrect/omitted information may delay or cause your application not to be processed for final review.

PLEASE PRINT LEGIBLY

Name / Phone Number / Relationship to Applicant
Mailing Address / City / State / Zip Code
Name / Phone Number / Relationship to Applicant
Mailing Address / City / State / Zip Code
Name / Phone Number / Relationship to Applicant
Mailing Address / City / State / Zip Code
Name / Phone Number / Relationship to Applicant
Mailing Address / City / State / Zip Code

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION FORM:

I certify that all statements made on this application are true and correct. I authorize former employers to release any information they may have regarding employment. I release from liability any person giving or receiving information pertinent to the investigation or verification of data provided in this application. If anything contained in this application and/or resumé is found to be untrue, I understand that I will be subject to dismissal or rejection. I understand that I will be subject to a personal interview and a photograph will be taken of me prior to the interview and attached to my application. I understand if I am accepted into the school, I will be required to have a physical examination and based on the information received from this exam, more information may be requested. I further understand that I will be required to be immunized for various diseases as recommended by the Texas Department of Health. I consent to random drug testing by urinalysis or blood tests to determine substance use and/or abuse at any time during the application process and/or school year. I understand a criminal background/history check will be made by Huntsville Memorial Hospital in the application process and the Texas Board of Nursing in order to attend school. The BON background check may result in my failure to be eligible to attend the Joe G. Davis Vocational School of Nursing or for taking the state board exam and licensure as a Vocational Nurse in the State of Texas.

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Printed Name

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Signature Date

OFFICIAL HIGH SCHOOL/GED/COLLEGE TRANSCRIPTS MUST BE SUBMITTED WITH THIS FULLY COMPLETED AND SIGNED APPLICATION.