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Apply for Certified Nursing Assistant (CNA) or Certified Medication Aide (CMA)

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 (CNA) or Certified Medication Aide (CMA)
Department:Nursing
Community Location:Heritage Ridge - 1502 Fort Crook Rd
City and State:Bellevue, NE
Hours :Day, Evening and Overnight
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General Information
* First Name:
* Last Name:
Address 1:
Address 2:
* City:
* State:
Zip Code:
* Phone:
Email:
Applicants - Please include your Email for communications. Associate making Referrals - If Email is unknown leave blank.
Start Date Availability:
Pay rate desired:
If applying for volunteer opportunities leave blank
Types of employment preferred:
   
   
   
   
   
   
Availability:
   
   
   
   
   
   
   
   
   
* Were you referred by a current employee: Yes    No   
Application Information
Referred By:
* Source:
Application
PERSONAL INFORMATION
Yes   No
Yes   No
Yes   No
Yes   No
EDUCATION

Tell us the highest level of education you have completed that applies to this position.

Yes   No
High School Diploma/GED
Associates
BA/BS
MA/MS
PhD
EdD
EMPLOYMENT HISTORY

List your most recent employer. (If none, leave blank.)

Employer 1
AUTHORIZATION

The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

Career Interests - Omaha Metro Area - Nursing
Tell us more about the types of opportunities you are interested in!
* What Certifications or Licenses do you currently hold?
Certified Caregiver
Certified Medication Aide (CMA)
Certified Medication Tech (CMT)
Certified Nursing Aide (CNA)
Licensed Practical Nurse (LPN)
Registered Nurse (RN)
DOT
DPT
My certification is not active but can be renewed
I am currently working on obtaining a certification
I am very interested in a Healthcare career and would like to earn my certification with your help
* What states are your licenses or certifications registered in?
Iowa
Iowa Compact State
Nebraska
Nebraska Compact State
None/NA
* Are you available to work weekends?
Yes
No
* How many years of Caregiver OR Nursing experience do you have?
0-1 years
1-3 years
3-5 years
5 years or more
None
* What is the best way to contact you regarding a career opportunity?
Phone
Text
Email
* What locations would you be interested in working at?
The Heritage Legacy - 2961 S. 169th Plaza, Omaha, NE
Heritage Pointe - 16811 Burdette St, Omaha, NE
Heritage Ridge - 1502 Fort Crook Rd, Bellevue, NE
The Heritage at Sterling Ridge - 1111 Sterling Ridge Dr, Omaha, NE
The Heritage at Fox Run - 3121 Macineery Dr, Council Bluffs, IA
Home Health/Hospice - 16934 Frances St, Omaha, NE
Do you have any experience as a Charge Nurse, Lead Nurse, Director of Nursing, Director of Healthcare OR other Nurse leadership role?
0-1 years
1-3 years
3-5 years
5 years or more
None
Equal Opportunity Employment
If you are an Associate Referring someone please select "Choose Not to Respond" to the following questions.

We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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