Application

Grace Homes is currently accepting applications for Certified Nursing Assistants in good standing on the Minnesota Nursing Assistant Registry. The ideal candidate will have prior experience in working with the geriatric population in memory care.

Employment Application

Full Name

Email Address

Street Address

City    State     Zip

Cell Phone #    Other Phone #

Position Applying For  Full TimePart Time

What date can you start working?

Do you have a current driver's license? YesNo

Can you prepare meals for groups of 8 or more? YesNo

Are you over the age of 18? YesNo (if under 18, hire is subject to verification of legal minimum age)

If hired, would you be able to provide evidence of US Citizenship or legal right to work in the United States?
YesNo

Have you ever been convicted of any criminal offense (felony or misdemeanor?)
YesNo

If yes, please describe the crime(s), nature of the crime(s), when & where convicted, & disposition of the case.

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, the surrounding circumstances and the relevance of the offense to the position(s) applied for will be considered.)

Education, Training, And Experience

Did you graduate form high school? YesNo

Have you attended a college or university? YesNo

If yes, name of school, city & state

Number of years completed    Did you graduate? YesNo   Degree/Diploma


Have you attended a vocational school? YesNo

If yes, name of school, city & state

Number of years completed    Did you graduate? YesNo   Degree/Diploma


Have you been in the military? YesNo

Branch     Rank     Dates of service

Honorable discharge?YesNo

Skils and duties

Related details


Past & Present Employment

Name of employer     Supervisor

Business type Telephone   

Address    City    State     Zip

Length of employment   May we contact this employer? YesNo

Position and duties

Reason for leaving

 

Name of employer     Supervisor

Business type Telephone   

Address    City    State     Zip

Length of employment   May we contact this employer? YesNo

Position and duties

Reason for leaving

 

Name of employer     Supervisor

Business type Telephone   

Address    City    State     Zip

Length of employment   May we contact this employer? YesNo

Position and duties

Reason for leaving

 

Name of employer     Supervisor

Business type Telephone   

Address    City    State     Zip

Length of employment   May we contact this employer? YesNo

Position and duties

Reason for leaving


List any licensures and certifications held