CNA/NA - Full Time - Nights or Part Time

General Information

Date

Name

First

Last

Email

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Have you ever applied to, or worked for us before?

Yes
No

If yes, when?

If hired, can you provide documents required to establish your eligibility to work in the US?

Yes
No

Are you above the minimum work age of 16?

Yes
No

Have you ever been convicted of a felony?

Yes
No

If yes, please explain.

What position are you applying for?

Hours Available

Part-Time
Full-Time
Summer

If Part-time, how many hours per week?

If hired, when you can you start work?

Rate of Pay Desired:

Education

High School

Please include: name & location of school, degree/diploma received, and # of years completed

College/University

Please include: name & location of school, degree/diploma received, and # of years completed

Technical

Please include: name & location of school, degree/diploma received, and # of years completed

Other skills & qualifications

Record of Employment

Employer #1

Position Held

Supervisor's Name

Supervisor's Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Start Date

End Date

Beginning Salary

Ending Salary

Duties

Reason for Leaving

Employer #2

Position Held:

Supervisor's Name

Supervisor's Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Start Date

End Date

Beginning Salary

Ending Salary

Duties

Reason for Leaving

Employer #3

Position Held:

Supervisor's Name

Supervisor's Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Start Date

End Date

Beginning Salary

Ending Salary

Duties

Reason for Leaving

Work Related References

Do not include relatives

Reference #1 Name

Occupation

Years Known

Reference Phone Number

Reference Email

Reference #2 Name

Occupation

Years Known

Reference Phone Number

Reference Email

Reference #3 Name

Occupation

Years Known

Reference Phone Number

Reference Email

To be completed by Nursing service applicants:

If you are not applying for a nursing position, please skip this page.

Are you willing to rotate shifts?

Yes
No

If no, which shift do you prefer?

In which specific areas do you have nursing experience?

License #

State of

If applying as a nurse aide, have you had a nurse aide training course?

Yes
No

Are you certified?

Yes
No

Documents

Upload your resume

Click or drag a file to this area to upload.

Upload your cover letter

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Additional Information

Signature

I hereby authorize Sacred Heart Monastery to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I understand that if offered employment, the offer may be contingent on my passing a pre-employment alcohol and drug screen and a pre-employment physical. By signing this application, I voluntarily agree to submit to a pre-employment alcohol/drug screen and pre-employment physical upon request. I understand that failure to pass the alcohol/drug screen and/or physical will result in withdrawal of the employment offer. If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state laws. I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid driver’s license. I also understand that any offer of employment is contingent on my ability to be covered by Sacred Heart Monastery’s auto insurance if required for my position. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered. My signature below certifies that I have read and understand the foregoing, and agree to the terms and conditions outlined, and that I seek employment under these conditions.

Signature

Date

CNA/NA – Full Time – Nights or Part Time – Evenings

General Information

Education

Record of Employment

Work Related References

To be completed by Nursing service applicants:

Documents

Signature

Benedictine Sisters of Sacred Heart Monastery