NURSING ASSISTANT TRAINING PROGRAM

Transcription

1 NURSING ASSISTANT TRAINING PROGRAM ADMISSION APPLICATION Name: Date f Birth: SS#: Address: City: State: Zip: Phne: C( ) H ( ) Occupatin: Emplyer: Address: _ EMERGENCY CONTACT: Name: Address: City: Relatinship; State: Zip: Tel:( ) EDUCATIONAL BACKGROUND (HIGHEST EDUCATION ATTAINED): ATTENDED HIGH SCHOOL SOME COLLEGE POST COLLEGE HIGH SCHOOL DIPLOMA/ GED ASSOCIATE/ BACHELOR S DEGREE WORK EXPERIENCE: (PLEASE LIST BEGINNING WITH MOST RECENT) YEAR JOB TITLE OCCUPATION/ EMPLOYER DUTIES & RESPONSIBILITIES Hw did yu find ut abut Nightingale Healthcare Prfessinals?: Persnal Referral (name) Faxed/ Psted flyer (place) Other (please be specific) I hereby certify all the abve t be true and crrect t the best f my knwledge Tday s Date: Signature f Applicant "Yur Future in Healthcare Starts Nw!"

2 NURSING ASSISTANT TRAINING PROGRAM ENROLLMENT AGREEMENT Name: Date f Birth: SS#: Address: City: State: Zip: Phne: C( ) H( ) TOTAL CLOCK HOURS OF INSTRUCTION: 150 HOURS PROGRAM LENGTH: 21 DAYS (DAY PROGRAM) 30 DAYS (EVENING PROGRAM) SPECIFIC TIMES OF CLASS ATTENDANCE (DAY PROGRAM): SPECIFIC TIMES OF CLASS ATTENDANCE (EVENING PROGRAM): 8:00am 4:30pm 3:00 pm 8:00 pm TYPE OF DOCUMENT AWARDED UPON COMPLETION: Upn successfully cmpleting all requirements f the curse, the student will receive a Certificate f Cmpletin. Scheduled Start Date: Scheduled Cmpletin Date: FEES AND CHARGES Applicatin Fee (nn-refundable) $ Nursing Assistant Training Prgram Fee includes: $ O Tuitin Fee Textbk Skills CD Ttal Nursing Assistant Training Prgram Fee $1, Additinal Fees-Students Respnsibility O ARC Testing Fee Unifrms Stethscpe (ptinal) Gait Belt (ptinal) White Shes Watch with secnd hand "Yur Future in Healthcare Starts Nw!"

3 CERTIFIED NURSING ASSISTANT TRAINING By attending the 21-day full-time r 30 day (Evenings Only) part-time Nursing Assistant training class at Nightingale Healthcare Prfessinals and becming a CNA by passing the ARC cmpetency exam, graduates can begin wrking at the entry level f the healthcare field; a persn can literally be n their way, climbing the career ladder that leads t height sin the medical field nly limited by the student themselves. A firm healthcare training backgrund prvides the basis fr a transitin in t ther patient care areas including LVN, RN, nurse practitiner, PA,etc. CNA training is a truly viable ptin fr all participants: The U.S. Bureau f Labr Statistics estimates that healthcare related ccupatins are and will cntinue t be the fastest grwing area f emplyment fr the next decade. The training perid required is 150 hurs; there are n pre-requisites, n requirements f a high schl diplma r GED. The hurs are brken dwn int 50 hurs thery and 100 hurs f hands-n training; we train with residents wh reside in area skilled nursing facilities. The maximum student teacher rati is 15:1 thereby allwing thse students requiring special attentin t receive it. We truly have a "n student left behind" philsphy. Emplyment is usually btained immediately after passing the American Red Crss Certificatin Test. We ffer assistance with jb placement as well. CNA literally wrk any given hurs f the day r night. Many careers are restricted tday time and evening hurs, nt s with the CNA. There are night shifts as well. Mst facilities are s shrt staffed that there is a lt f vertime available which is paid at a rate f time and a half fr 9 t 12 hurs and duble time fr13 t 16 hurs. The starting salary fr CNA's is $13 t $14 an hur with benefits fr thse wh wrk a full time schedule. There are als ther reasns fr referring yur clients t the CNA training prgram ffered by Nightingale Healthcare Prfessinals: 1. The training lcatin, at 8105 Edgewater Dr. Suite 290, Oakland is n a majr bus rute fr thse traveling by public means. Fr thse driving, there is plenty f free parking-n searching fr parking places n the street r having timed meters We ffer jb assistance by prviding students with verified jb leads, in the frm f phne numbers, addresses and cntact persn(s) t ver 50 nursing hmes in the bay area. We ffer resume preparatin and caching, interview skills develpment and prper attire.

4 \\ PAGE2 CERTIFIED NURSING ASSISTANT TRAINING 4. The classes are small with 15:1 student/instructr ratis, and individualized attentin. 5. We have excellent relatinships with the Nursing Facilities where students receive their clinical training, and where sme students have been placed in emplyment capacities. Fr enrllment and training questins, cntact ur ffice r ur schl Directr, Vernica Taylr-Henry, RN, BSN, PHN at $150 Applicatin Fee Cst fr the Prgram is Fees Breakdwn: $250 $150 Depsit Supplies (bks and curse materials) $500 Tuitin TtalFees $1,050 Other csts t student: American Red Crss Cmpetency Testing Fee BLS (CPR Certificatin) OPTIONAL Live Scan $90 $75 (Includes Mandatry Bk) $49 NOTE: These prices are based n prices frm Unifrm Advantage n Christie Ave in Emeryville. They will give 10% ff f these prices if yu tell them yu will be a NHP Student. Yu may chse t get yur supplies frm anther stre if yu wish. Analg watch with secnd hand Wine unifrm (scrubs) $23.00 $30.00 White shes $30.00 Stethscpe-B/Pcuff (cmbinatin) $40.00 Gait Belt $12.99 Requirements frprgram: Pass a criminal backgrund check. Obtain TB test and clearance(must be within the past year) Obtain a physical (Must be within the past year)and a flu sht during the mnths f Nv 1 thru March 31 st nly (flu seasn) NightingaleHealthcarePrfessinals"YurFutureinHealthcareStartsNw!" 8105 EdgewaterDrive,Suite290, Oakland,CA94621 (510) fax(510) CanynDrive,Suite101,Pinle,CA94564(510) Fax(510)

5 THESE TESTS MUST BE COMPLETED BEFORE ANY DIRECT PATIENT CONTACT MUST have TB test, Livescan, Physical and Flu Sht (flu seasn Nv 1 thru Mar 31) Make arrangements t cmplete them befre 1 st day f class. Cannt miss thery hurs t get tests cmpleted. TBTESTSAVAILABLEATTHISLOCATION: Must call at 5:45 pm and smene will call yu back fr appintment Berkeley Free Clinic 2339 Durant Avenue Berkeley,CA (510) Free Open daily LIVESCAN AND PHYSICALSAVAILABLEAT THIS LOCATION: N appintment needed Occupatinal Testing Center 2475 West 12 th Street Oakland, CA (510) Physical $49 Open Mn Sat Livescan $49 Open Mn - Sat PHYSICAL, TB TEST AND FLU SHOTS AVAILABLEATTHIS LOCATION: Open Mn Fri 10 am till 5 pm N appintment needed Dr. Knstantin 2584 MacArthur Blvd. Oakland,CA (510) (510) FAX $40 fr all 3 (best value) $20 TB test nly $30 Physical nly Flu sht free with TB r Physical

6 MedicalExaminatinReprt STUDENT NAME: S.S. # DATE OF BIRTH: Please have the examiner fill ut the infrmatin requested in each area. In sme cases nly a MD may verify treatment f medical clearance t participate in the Nursing Prgram. Turn in cmpleted frm t NHP administrative ffice n the first day f class. Please Circle: MALE FEMALE DATE OF EXAMINATION: HEIGHT: WEIGHT: PULSE: /MIN RESP BLOOD PRESSURE: VISUALACUITY: RT EYE: LEFT EYE: VISUAL ACUITY WITH CORRECTIVE LENS : RT EYE: LEFT EYE: CHECKLIST NORMAL ABNORMAL DETAILED DESCRIPTION OF ABNORMAL FINDINGS HANDS/SKIN HEADEYES EAR/NOSE/THROAT/MOUTH NECK/NODES CHEST/LUNGS CARDIOVASCULAR ABDOMEN MUSCULOSKELETAL NERVOUS SYSTEM

7 STUDENT EXAMINATION OUTCOME I have examined and fund that the student is FREE f (Student's Name) Cmmunicable diseases and des nt have any cnditin that wuld create a hazard t himself/herself, fellw students, patients, and visitrs. I have examined and fund a cnditin at (Student's Name) this time that appears t PREVENT this persn frm fulfilling the requirements as described abve. (Please describe cnditin and recmmendatins belw.) PHYSICIAN'S PRINTED NAME: PHYSICIAN'S SIGNATURE: ADDRESS: TELEPHONE NUMBER: TB TEST Intradermal Skin Test (PPD Mantux) Date Tested Result If Psitive skin test, a medical physician must enter in the fllwing infrmatin: Date f Chest x-ray: (Within the Past Year) Result: (Chest X-ray and Questinnaire must be dne annually) Has this patient been prescribed any Chemtherapy t treat B? Prescribed and what prescriptin/regimen? What medicatins are

8 STATE OF CALIFORNIA BCIA 8016 (rig. 4/2001; rev. 01/2011) DEPARTMENT OF JUSTICE Applicant Submissin A1226 ORI(Cde assigned by DOJ) REQUEST FOR LIVE SCAN SERVICE Certificatin Authrized Applicant Type Certified Nurse Assistant (CNA) r Hme Health Aide (HHA) Type f License/Certificatin/Permit OR Wrking Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned) Cntributing Agency Infrmatin: Califrnia Department f Public Health (CDPH) Agency Authrized t Receive Criminal Recrd Infrmatin Mail Cde (five-digit cde assigned by DOJ) MS 3301, P.O. Bx Street Address r P.O. Bx Sacrament CA Cntact Name (mandatry fr all schl submissins) City State Zip Cde Cntact Telephne Number Applicant Infrmatin: Last Name First Name Middle Initial Suffix Other Name (AKA r Alias) Last Date f Birth Sex Male Female First Name Driver's License Number Height Weight Eye Clr Hair Clr Billing Number (Agency Billing Number) Misc. Place f Birth (State r Cuntry) Scial Security Number Number (Other Identificatin Number) Suffix Hme Address Street Address r P.O. Bx City State Zip Cde Yur Number: DOJ FBI Level f Service: OCA Number (Agency Identificatin Number) If re-submissin, list ATI number: (Must prvide prf f Rejectin) Emplyer (Additinal respnse fr agencies specified by statute): Nightingale Healthcare Prfessinals Emplyer Name 8105 EdgewaterDr.,Ste.290 Street Address r P.O. Bx Original ATI Number Mail Cde (five-digit cde assigned by DOJ) Oakland CA City State Zip Cde Telephne Number (ptinal) Live Scan Transactin Cmpleted By: Name f Operatr Date Transmitting Agency LSID ATI Number Amunt Cllected/Billed ORIGINAL - Live Scan Operatr SECOND COPY - Applicant THIRD COPY (if needed) - Requesting Agency