Application PATIENT CARE ACADEMY

Application PATIENT CARE ACADEMY

APPLICATION PROCESS OVERVIEW Applications are accepted all year. Specific start dates can be found on our website. http://grovescenter.kvcc.edu/career/pca/ Staff will begin your application review with 3 days of receipt. There are 5 steps: 1) Review fundamental eligibility 2) Contact references 3) Successfully complete the math and reading assessments 4) Personal interview 5) Acceptance/Denial The application process is competitive and only 12 seats are available in each session. Candidates are offered seats when they are determined to be eligible. APPLICATION STEPS 1) Fundamental Eligibility Our staff will review your written application for these points: Application is legible and all questions have been answered. Written answers demonstrate attention to detail, the ability to convey information in writing and an evidence and understanding of the question being asked. Self-reported interest in a career which requires the ability to keep up with the physical demands of the position, such as performing strenuous work. Self-reported desire to work with patient and customers in a health care system. Must be at least 18 years old and have a high school diploma or GED. 2) References Give careful thought to the references you provide. Your application cannot move forward until we communicate with your references. We will contact them within 3 days of receiving your application. Please alert them and encourage them to respond as quickly as possible. References will be asked to: Validate the candidate s reliability and readiness to work. Verify the candidate s ability to follow direction. Verify their ability to work with others as part of a team. We cannot accept references from family members. 3) Math Skills and Reading Assessment Success in the academy requires the ability to apply math skills in order to perform work. These skills are generally acquired in elementary school. The assessment will be scheduled within 10 days of being contacted. The assessment tests knowledge in: Solving Multiplication Story Problems Solving Division Story Problems Expressions in 1 Variable Locating What s Important in Expository Text You must score at least 80% on each module to meet the requirements. We allow two attempts at passing the tests. You are allowed to use a calculator on the exam. It is not uncommon for candidates to require a second math test to be successful.

The tests must be taken in the presence of a proctor. We will work with you to find a suitable location within a reasonable driving distance to take the assessment. 4) Interview The interview will be scheduled immediately after the math assessment. Behavior based questions are used to aid staff and candidates in determining readiness for the course. In most cases, you will be notified of the outcome within one week of the interview. 5) Criminal Background Check, Immunization Report, Physical Exam, TB Test, and Registration Before being accepted into the program, there are some remaining requirements. You ll be notified by phone and a registration packet will be mailed to you. 1) You will need to pass a criminal history check. The state of Michigan requires a LiveScan criminal background check for work in a healthcare setting. The LiveScan criminal background check costs $55-65. 2) You will be required to obtain a copy of your current immunizations. A list of required immunizations will be provided. If you cannot obtain your immunization records, you can request a titer. 3) All students in the must have a current physical examination. Physical exam forms will be provided. 4) A negative TB test is required. 5) A registration form must be returned to The Groves Center to secure your seat in the class. 6) A $250 deposit is required to hold your seat in the program. The remaining fee will be due two weeks prior to the start of class. Please retain these pages for future reference. Call 269-353-1286 or email us at careeracademies@kvcc.edu if you have any questions.

PERSONAL INFORMATION Last Name: First Name: Middle Initial: Mailing Address: City: State: Zip: Home : ( ) Cell : ( ) E-mail: CRITERIA Are you 18 years of age or older? Yes No I understand that employment in the health care field as a patient professional is likely to require me to work directly with patients and customers in the health care system. I am willing and able to accept this type of employment. I understand that this occupation requires the ability to perform strenuous work, stamina, good physical condition, good health, and personal hygiene Yes Yes No No I understand that employment in health care is likely to require that I have no visible tattoos or piercings. Yes No I understand that clinical training and employment in a health care setting requires that I have a clean criminal background. Yes No EDUCATION HISTORY Name of School/College Attended Course of Study Degree Diploma/Degree Completed High School/GED Graduate Yes No Some College Yes No Technical Training Yes No Two Year Degree Yes No Four Year Degree Yes No Graduate School Yes No Have you earned any occupational licenses or certificates? Yes No If yes, please list: Are you legally able to work in the United States? Yes No If you answered no, please explain: Have you ever been convicted of a felony or misdemeanor? Yes No If yes, please explain (include dates and details): In your own words, tell us why you have applied to the and how this training fits into your professional goals.

REFERENCES: KVCC will seek feedback from the references in this section to gain information related to: your ability and willingness to fulfill commitments you make your ability to communicate effectively with others and to work as a member of a team your positive attitude toward work Provide the names, phone numbers, and email addresses of at least two professional/work related and/or educational references. KVCC may also contact your former employers to gather feedback related to this application. We recommend you inform your references in advance so that they can be prepared for our call. DO NOT list relatives. If you list a friend, they must be work related. Name Number Email Address Relationship Years known EMPLOYMENT HISTORY: List all the places you have been employed. Start with your present or most recent employer and continue listing all the places you have worked. Add additional pages, if needed. Employer: Immediate Supervisor: Address City State Zip Code From: To: $ Annual Salary Per Hour Job Title/Position Hours per week Earnings Duties and responsibilities: Reason for leaving: Employer: Immediate Supervisor: Address City State Zip Code From: To: $ Annual Salary Per Hour Job Title/Position Hours per week Earnings Duties and responsibilities: Reason for leaving: Employer: Immediate Supervisor: Address City State Zip Code From: To: $ Annual Salary Per Hour Job Title/Position Hours per week Earnings Duties and responsibilities: Reason for leaving:

How did you hear about this program? PATIENT CARE ACADEMY QUESTIONNAIRE: 1. Please list five qualities you possess that would make you an ideal candidate for the. 2. Briefly describe what you believe being a good patient care professional requires. 3. What would you do if you heard or witnessed a fellow employee physically or verbally abusing a resident? I affirm that all information provided by me to the Kalamazoo Valley Community College is complete, true, and accurate to the best of my knowledge and belief. Such information contains no omissions, misrepresentations, or concealment of fact. I am aware that all information given and statements provided during the application process are subject to investigation. I give my permission for KVCC to contact my references and former employers to obtain additional information regarding my background for the purpose of responding to my request for admission to the Academy. Print Full Name Signature of Applicant Date

Additional space for question answers. Please reference appropriate question number.