NURSING ASSISTANT TRAINING PROGRAM

Transcription

1 NURSING ASSISTANT TRAINING PROGRAM ADMISSION APPLICATION Name: Driver License r State ID Number: State: Height: Date f Birth: Address: Weight: Eye Clr: Hair Clr: SS#: City: State: Zip: Phne: ( ) cell r hme (circle ne) Occupatin: Emplyer: EMERGENCY CONTACT: Name: Relatinship: Tel: ( ) Alternate Phne: ( ) 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: 160 Hurs (60 hurs Thery & 100 hurs Clinical) PROGRAM LENGTH: Varies per time f prgram yu select. SPECIFIC TIMES OF CLASS ATTENDANCE (DAY PROGRAM): SPECIFIC TIMES OF CLASS ATTENDANCE (EVENING PROGRAM): 8:30 am 4:30 pm 5:00 pm 10:00 pm *DAYS AND TIMES SUBJECT TO CHANGE* 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: $ Ttal Nursing Assistant Training Prgram Fee $1, Additinal Fees - Students Respnsibility State Clearance Frms (TB, Physical, Live scan, Flu sht) ARC Testing Fee Unifrms Stethscpe (ptinal) Gait Belt (ptinal) White/Black Shes with slip resistant sle Watch with secnd hand "Yur Future in Healthcare Starts Nw!"

3 CERTIFIED NURSING ASSISTANT TRAINING Once yu have successfully cmpleted the Certified Nursing Assistant training prgram at Nightingale Healthcare Prfessinals and passed the American Red Crss (ARC) cmpetency exam, yu will be perfectly psitined t begin wrking at the entry level in the health care field. Yu can literally be n yur way and climbing the career ladder that leads t heights in the medical field nly limited by the student themselves. A firm healthcare training backgrund prvides the basis fr a transitin int 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 160 hurs; there are n pre-requisites, n requirements f a high schl diplma r GED. The hurs are brken dwn int 60 hurs f thery and 100 hurs f hands-n training. We train with residents wh reside in 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 easily btained immediately after passing the American Red Crss cmpetency exam. We ffer assistance cnnecting students with jb pprtunities as sn as they begin the prgram A CNA can literally wrk any given hurs f the day r night. Many careers are restricted t either day time r evening hurs, which is nt the case with the CNA. There are night shifts as well as vernight shifts. A lt f facilities are s shrt staffed that there are can als be a lt f vertime available which is paid at a rate f time and a half fr 9 t 12 hurs and duble time fr 13 t 16 hurs. The average starting salary fr a CNA is arund $15 an hur with benefits fr thse wh wrk a full-time schedule. Additinal Benefits t furthering yur educatin with Nightingale: 1. The training lcatin, at 903 University Ave, in Berkeley is n a majr bus rute fr thse traveling by public means. Fr thse driving, there is plenty f free street parking 2. 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 acrss the east, nrth and suth Bay Area. 3. We can ffer assistance with resume preparatin and caching, interview skills develpment and prper attire. Letters f recmmendatin are als available fr students in gd standing. "Yur Future in Healthcare Starts Nw!"

4 PAGE 2 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 at Prgram Cst and Fee Breakdwn: $150 Applicatin & Registratin Fee $1000 Training & Instructin Fee (Bk included) Ttal Fees $1,150 The ttal f $1,150 can be paid in full r a payment agreement can be set up. All fees must be cmpleted n r befre the first day f the last week f the prgram. Other csts t student: Live Scan TB Test Physical Flu Sht (nly during Flu seasn) $52.00 (varies per lcatin) Free - $25.00 (varies per lcatin) $30 (varies per lcatin) Free - $32.00 (varies per lcatin) Analg watch with $23.00 secnd hand Unifrm/Scrubs $30.00 (Wine/Burgundy clred) White r Black shes $30.00 Stethscpe - B/P cuff (cmbinatin) pt. $40.00 Gait Belt ptinal $12.99 BLS/CPR Certificatin ptinal $55 (reflects enrlled student discunt) American Red Crss $105 Cmpetency Testing Fee NOTE: The prices listed fr unifrm specific items are based n prices frm Unifrm Advantage n Christie Ave in Emeryville. They will give 10% ff 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. Requirements fr Prgram: All students must pass a criminal backgrund check thrugh the Live Scan. Obtain TB test with clearance; btain a physical with clearance and a flu sht during Flu Seasn (Octber 1 st thru March 31 st ). Previus fingerprinting is nt transferable. We will accept dcumentatin f a physical, TB test, r flu sht taken with 6 mnths f prgram start date. "Yur Future in Healthcare Starts Nw!"

5 MEDICAL EXAMINATION REPORT 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 f Examinatin: HEIGHT: WEIGHT : PULSE: /MIN RESP BLOOD PRESSURE: VISUAL ACUITY: VISUAL ACUITY WITH CORRECTIVE LENS: RT EYE: LEFT EYE: RT EYE: LEFT EYE: CHECKLIST NORMAL ABNORMAL DETAILED DESCRIPTION OF ABNORMAL FINDINGS HANDS/SKIN HEAD EYES EAR/NOSE/THROAT/MOUTH NECK/NODES CHEST/LUNGS CARDIOVASCULAR ABDOMEN MUSCULOSKELETAL NERVOUS SYSTEM "Yur Future in Healthcare Starts Nw!"

6 STUDENT EXAMINATION OUTCOME I hereby certify we have examined and fund them (Student's Name) S.S. # DATE OF BIRTH: Cleared withut limitatin Yes r N Nt cleared fr this reasn Physician s Printed Name: Physician s Signature: Address: Telephne Number: TB TEST Intradermal Skin Test (PPD Mantux) Date Tested Negative Psitive 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 TB? What medicatins are prescribed and what prescriptin/regimen? Flu Sht (Flu Seasn Octber March) I have given the (Student's Name) (Flu sht Series) PHYSICIAN'S SIGNATURE: "Yur Future in Healthcare Starts Nw!"

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8 ALL CLEARANCE FORMS MUST BE COMPLETED BEFORE ANY DIRECT PATIENT CONTACT Please make arrangements t cmplete these requirements befre the first day f class. A TB test, Livescan, Physical and Flu Sht (flu seasn: Oct 1 st thru Mar 31 st ) are necessary t participate in clinical and will be required the first day f class. Yu cannt miss class hurs t get tests cmpleted. Please be advised these lcatins are here as an ptin, yu may chse t accmplish these requirements at any lcatin cnvenient and within yur means. TB TESTS AVAILABLE AT THIS LOCATION: - Berkeley Free Clinic: 2339 Durant Avenue Berkeley, CA Cst: Free Call (510) at 5:45 pm t schedule an appintment - Rts Cmmunity Health Center: 9925 Internatinal Blvd #5 Oakland Ca Cst: $25 Call (510) t schedule an appintment LIVESCAN AND PHYSICALS AVAILABLE AT THIS LOCATION: Fr a list f lcal vendrs visit (OCA Number is yur Scial Security Number) Occupatinal Testing Center 1 Market Street Oakland, Ca (510) N appintment needed Physical $40 Open Mnday Friday Livescan $52 Open Mnday Friday PHYSICAL, TB TEST AND FLU SHOTS AVAILABLE AT THIS LOCATION: Open Mn Fri 10am - 4:30pm N appintment needed Dr. Knstantin $50 fr all 3 (best value) 2584 MacArthur Blvd. $30 TB test nly Oakland, CA $40 Physical nly (510) Flu sht free with TB r Physical (while supplies last) "Yur Future in Healthcare Starts Nw!"