Apply for CNA/Nurse's Aide

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

Summary
Title:CNA/Nurse's Aide
ID:04324
Location:Montpelier, ID
Department:Bear Lake Manor
Salary Range:Minimum starting wage of $14.25, increases based on qualifications and experience
Classification:Full Time/Regular Part Time/Occasional
Experience:Previous experience preferred.
Education:High School Diploma or GED Required.
Benefits:Depending on job status; Full Benefit Package; Medical, Dental, Group Life Coverage, Retirement, Sick Leave, Vacation and Holidays. Free Employee Gym Membership, Employee Assistance Program.
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Contact Information
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* Last Name:
* Address 1:
Address 2:
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Attachments
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Application for Employment
PERSONAL INFORMATION
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EMPLOYMENT DESIRED
FT (40 hr/wk)   RPT (32 hr/wk)   Occasional (<30 hr/wk)   PRN (as needed)   Temp (<6 months)
  
  
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GENERAL DATA
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EDUCATION

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

School 1

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School 2

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School 3

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School 4

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School 5

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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

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Employer 5

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PROFESSIONAL LICENSE, REGISTRATION OR CERTIFICATION DATE

List all professional licenses, registrations, and certifications:

PROFESSIONAL LICENSE, REGISTRATION OR CERTIFICATION

PROFESSIONAL LICENSE, REGISTRATION OR CERTIFICATION 2

PROFESSIONAL LICENSE, REGISTRATION OR CERTIFICATION 3

PROFESSIONAL LICENSE, REGISTRATION OR CERTIFICATION 4

PROFESSIONAL LICENSE, REGISTRATION OR CERTIFICATION 5
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REFERENCES

Please provide three references (not relatives).

Reference 1

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Reference 2

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Reference 3
CERTIFICATION AND AGREEMENT (Please read the following before signing)

I certify that the information I provided in this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of facts in this application disqualifies me from further consideration, or, if I am employed, is sufficient cause for dismissal regardless of when the misrepresentation or omission of fact is discovered

I authorize investigation of all statements contained in this application and understand that I may be required to provide verification (diploma, license, transcripts, type tests, etc.) of information contained in this application. I authorize any and all persons, companies, or agencies to release to Bear Lake Memorial Hospital any and all information they may have, which is relevant to the application process. I also release all such parties from any liability that may result from furnishing information to Bear Lake Memorial Hospital.

I understand that if I am employed with Bear Lake Memorial Hospital, my employment will be at-will. As such it can be terminated by me or by Bear Lake Memorial Hospital with or without advance notice, at any time, and for any reason not prohibited by law.

I understand that any employment offer is contingent upon the following: (1) producing documents establishing my eligibility to work in the United States; (2) satisfactorily passing the pre-employment drug screen, employee health evaluation (if required), establishing that I am able to perform the essential functions of the position; the completion of a criminal background and reference checks; and (3) complying with Bear Lake Memorial’s pre-employment application procedures.

I have not been excluded, suspended or debarred from participating or providing services in any Medicare/Medicaid program or any other federally funded health care program, nor am I being investigated in any matter that could lead to my exclusion from a Medicare/Medicaid program or any other federally funded health care program.

I acknowledge that I have read the certification and agreement, and agree to abide by its terms.


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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