nurse aide training
enrollment checklist
training policies
training application
background check
class schedule

 

Nurse Aide Training Application

Name:

Address:

City: State: Zip:

Main Contact Phone:

Alternate Phone:

E-mail:

Date of Birth:

Drivers License Number:

Drivers License State:

Please see Training Policies "Candidate Admission, Course Completion, and Dismissal Policy".

Application Questions

1. Can you provide proof that you are legally eligible to work or train in the United States?

2. Have you ever been denied licensure or certification in any health care profession?

3. Do you have an interest in applying for a job with Columbine Health Systems?  If so, is there a particular facility you are interested in?

4. How did you hear about the program?

5. Please share your reasons for wanting to enroll in the program and why you would like to become a Certified Nursing Assistant.

6. Based on the information provided that describes the type of training provided in the class, do you believe you are able to perform the essential functions, i.e., lifting, bending, reaching, etc., with or without reasonable accommodation?

Due to the limited number of spots in each class, prospective students are not guaranteed a seat until all requirements have been met.  This includes submitting a completed application, having an approved criminal background check and payment of tuition in full.