Apply for Certified Nursing Assistant

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

Summary
Title:Certified Nursing Assistant
ID:1084
Location:St. Cloud, Minn.
Facility:Saint Scholastica Convent
Hours:PT 12 hr/wk
Shift:PM; 4:30 - 8:30 pm
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Application for Employment
PLEASE READ CAREFULLY:
Please answer all questions on this form to the best of your ability. Your qualifications will be carefully reviewed and you will be given thorough consideration for any suitable vacancies in the organization. If you are employed, this will become a part of your permanent personnel record. This information will be kept in strict confidence. Please read Applicant’s Notification and Agreement for employment details.


POSITION DESIRED
* How did you learn about this job opportunity? :
* Position desired or type of work interested in:
* Type of employment desired:
Regular Full-Time
Regular Part-Time
Temporary
Day Shift
Evening Shift
Overnight Shift
* Wage or salary desired:
* Date available for work?:
* Specific days and times available for work:
* Have you previously applied to our organization?:
Yes   No
If Yes, when?:
* Do you have any relatives employed by Sisters of the Order of Saint Benedict?:
Yes   No
If Yes, name/relationship:
* Have you ever been employed by Sisters of the Order of Saint Benedict?:
Yes   No
If Yes, what positon?:
Dept.?:
Dates employed:
* Are you 18 years or older?:
Yes   No
* Are you legally authorized to work in the United States?:
Yes   No
If postion you are applying for requires driving, please provide:
Driver's license #:
State:
Class:

EDUCATIONAL BACKGROUND
Starting with your most recent school attended, provide the following information.

  School (Include City
& State)
Years Completed Completed Major/Minor
High School
Diploma
GED
Technical College
Diploma
Certification
Degree
Other
University/College
Diploma
Certification
Degree
Other
Other
Diploma
Certification
Degree
Other

SKILL AND QUALIFICATIONS
List any skills, experience, special training, licenses and/or certificates, and special accomplishments related to this positon:

EMPLOYMENT HISTORY
Beginning with your most recent employer, provide the following information. Include military service assignment. Please include employment history for a minimum of 10 years if possible.

List any other names used if different from the name on this application:

EMPLOYER 1

Dates Employed (Month / Year) Employer Name & Address Employer Phone
From:

To:

Job Title(s) (Starting and Final) Immediate Supervisor Name & Title

Full-Time or Part-Time? # Hours/Week
Full-Time   Part-Time
Specific Job Duties Reason for Leaving Salary
Starting:

Ending:

EMPLOYER 2

Dates Employed (Month / Year) Employer Name & Address Employer Phone
From:

To:

Job Title(s) (Starting and Final) Immediate Supervisor Name & Title

Full-Time or Part-Time? # Hours/Week
Full-Time   Part-Time
Specific Job Duties Reason for Leaving Salary
Starting:

Ending:

EMPLOYER 3

Dates Employed (Month / Year) Employer Name & Address Employer Phone
From:

To:

Job Title(s) (Starting and Final) Immediate Supervisor Name & Title

Full-Time or Part-Time? # Hours/Week
Full-Time   Part-Time
Specific Job Duties Reason for Leaving Salary
Starting:

Ending:

EMPLOYER 4

Dates Employed (Month / Year) Employer Name & Address Employer Phone
From:

To:

Job Title(s) (Starting and Final) Immediate Supervisor Name & Title

Full-Time or Part-Time? # Hours/Week
Full-Time   Part-Time
Specific Job Duties Reason for Leaving Salary
Starting:

Ending:

PROFESSIONAL REFERENCES List three business/work references not previously listed or individuals who are familiar with your qualifications (Do not list relatives or personal friends).

Name Address Phone Number How Do You Know This Person? # Years Known

APPLICANT'S NOTIFICATION AND AGREEMENT
I certify that all information I have provided in this application is true, complete, and correct. I understand that falsification, misrepresentation or omissions of any kind on this application or any other accompanying or required documents will be sufficient cause for elimination from further consideration for employment, denial of employment, or immediate termination of employment whenever it is discovered.

I authorize Sisters of the Order of Saint Benedict, its representatives, employees or agents to contact any or all of my past or present employers, supervisors, public agencies, licensing authorities, educational institutions, and all other references familiar with my employment qualifications and background to verify the accuracy of all information I have provided in this application and accompanying documents. I hereby voluntarily and knowingly release and hold harmless, waiving any and all right and claims I may have regarding the employer, its agents, employees or representatives for seeking information and all other persons, corporations or organizations for furnishing such information pertaining to me or my employment.

I understand Sisters of the Order of Saint Benedict is an Equal Opportunity Employer providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, familial status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Sisters of the Order of Saint Benedict complies with applicable federal, state and local laws governing non-discrimination in employment.

I understand that this application remains on active file for only 90 days.

I understand that information contained in this document or the granting of an interview is not intended to create an employment contract between Sisters of the Order of Saint Benedict and myself. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon Sisters of the Order of Saint Benedict unless made in writing.

I understand that if I am offered a position with Sisters of the Order of Saint Benedict at Saint Scholastica Convent, employment is contingent upon the following requirements: authorization and successful outcome of a Background Study submitted to the Minnesota Department of Human Services to determine clearance for the provision of direct contact services; authorization and completion of testing to ensure applicant is free from latent or active Tuberculosis infection; and provision and verification of job required license(s). I understand if I am offered a position at Saint Benedict’s Monastery, employment is contingent upon successful outcome of the following requirements for identified positions: authorization for a Background Study; and provision and verification of job required license(s).

I understand that if I am offered a job and accept it, Sisters of the Order of Saint Benedict reserves and retains the right to make such changes in the terms and conditions of my employment as the organization determines to be necessary or appropriate. I also understand that Sisters of the Order of Saint Benedict is an AT WILL Employer, and that I have the right to terminate my employment at any time, and that Sisters of the Order of Saint Benedict has the identical right.

I understand that, on the date of hire, based on federal immigration laws, I will be required to provide proof of identity and legal authorization to work in the United States (Employment Eligibility Verification, Form I-9).

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT’S NOTIFICATION AND AGREEMENT


I declare that I have read, fully understand and accept all terms of the Applicant’s Notification and Agreement.

* Signature (type name):
* Date:
Certified Nursing Assistant Questions
* Are you currently on the Minnesota Nursing Assistant Registry?
Yes
No
* This position requires the ability to lift a minimum of 50 pounds, can you meet this requirement?
Yes
No

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