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Advanced Health Care

Certified Nursing Assistant

AHC of Reno

Reno, Nevada

The Certified Nursing Assistant delivers care and assists patients in all aspects of daily living. Under the direction of the Director of Nursing and the facility nurses the CNA provides clinical support and personal assistance to each patient consistent with the prescribed treatment plan. CNA’s provide a variety of services with a friendly approach and a strong commitment to customer service.

* Required fields

Personal Information

Name *

Other Names

Address *

City *

Zip Code *

Home Phone *

Work Phone

Previous Address

City

Zip Code

Background Information

Have you ever been interviewed with AHC or its affiliates before? *

Yes No

If yes, list date(s), job title(s), & location(s) *

Have you ever been employed by AHC or its affiliates before? *

Yes No

If yes, list date(s), job title(s), & location(s) *

Are you eligible for re-hire? *

Yes No

Do you have any relatives employed by AHC or its affiliates? *

Yes No

If yes, list date(s), job title(s), & location(s) *

Are you at least 18 years old? *

Yes No

Have you ever been convicted of a felony? *

Yes No

Have you ever been sanctioned or disciplined by any state or federal authority or excluded from participation in the Medicare or Medicaid programs under Sec. 1128 of the Social Security Act? *

Yes No

Employment Interests

Position desired: *

Full-time Part-time Per diem

Would you consider working any shift? *

Yes No

If yes, which?: *

AM PM NOC

Weekends and Holidays? *

Yes No

Rotating shifts? *

Yes No

On call? *

Yes No

Do you have any medical and/or physical condition(s) or impairment(s) which may impact your ability to safely and effectively perform the duties of the position for which you are applying? *

Yes No

If yes, please describe *

Salary desired

Education/Training

High School Education

Name and Address of Institution

Course of Study

Years attended

Diploma/degree?

College Education:

Name and Address of Institution

Course of Study

Years attended

Diploma/degree

Other:

Name and Address of Institution

Course of Study

Years attended

Diploma/degree?

Professional Licenses and/or Certificates

Currently, I am:

Registered Licensed Certified Applied for

Type

Date Issued

Expiration Date

Number

Currently, I am:

Registered Licensed Certified Applied for

Type

Date Issued

Expiration Date

Number

Current restrictions (if any)

Other special knowledge, skills, or qualifications

Employment History

Are you employed at present? *

Yes No

May we contact your present employer? *

Yes No

Please list your previous employers, starting with the most current or recent employer. Attach resume if necessary/available.

Employer Name

Phone Number

Employer Address

Employed From

Employed Until

Job Title

Ending Salary

Supervisor's Name

Duties & Responsibilities

Reason for leaving

Employer Name

Phone Number

Employer Address

Employed From

Employed Until

Job Title

Ending Salary

Supervisor's Name

Duties & Responsibilities

Reason for leaving

Employer Name

Phone Number

Employer Address

Employed From

Employed Until

Job Title

Ending Salary

Supervisor's Name

Duties & Responsibilities

Reason for leaving

References

Please list the names, titles, and phone numbers of three former supervisors, managers, or teachers other than relatives.

First Reference

Second Reference

Third Reference

Certification and Acknowledgement

Applicant Signature *

Date: *

Upload Resume:

Arizona

AHC of Glendale AHC of Mesa AHC of Scottsdale

California

AHC of Sacramento

Colorado

AHC of Aurora AHC of Colorado Springs

Idaho

Aspen

Kansas

AHC of Overland Park

Nevada

AHC of Henderson AHC of Las Vegas AHC of Paradise AHC of Reno AHC of Summerlin

New Mexico

AHC of Albuquerque

Utah

AHC of Salem AHC of St. George Aspen Ridge Aspen Ridge of Utah Valley Aspen Ridge West Pine View

Certified Nursing Assistant

AHC of Reno

Reno, Nevada

Personal Information

Background Information

Employment Interests

Education/Training

High School Education

College Education:

Other:

Professional Licenses and/or Certificates

Employment History

Please list your previous employers, starting with the most current or recent employer. Attach resume if necessary/available.

References

Certification and Acknowledgement

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