Mercyhealth Nursing Assistant Training Program Application

Mercyhealth Nursing Assistant Training Program Application

This accelerated 88-hour program is offered over 4 weeks with students attending 8 days of lecture and 4 days of clinical. Classes are held Monday/Wednesday/Friday from 8am-4:30pm at MercyCare Building, and clinicals are held Monday/Wednesday/Friday from 6:15am-3pm at Mercyhealth Hospital and Trauma Center - Janesville. We typically schedule a "Meet & Greet" session on the Monday or Friday before the start of class, for you to meet your instructors, take badge photos, and obtain your textbooks.

PROGRAM EXPECTATIONS
Students are expected to arrive on time and follow program guidelines regarding cell phone use, dress code (including no artificial nails), and professional conduct. Students are given homework each class and are expected to actively participate in group discussion, activities, and hands-on skill demonstration with students, instructors, and manikins as appropriate. In each class, students will be tested on the previous class material. Only one absence (due to unforeseen circumstances) is allowed, and all absences must be made up prior to completing the final exam. Students must score an 80% to pass the course to be eligible to sit for the Wisconsin state CNA exam (including knowledge and skills return demonstration).

REQUIREMENTS
Completion of program entrance exam
Submission of vaccination record and background check with application
Receipt of class payment in the amount of $525 (payment instructions will be provided once your acceptance to the program has been confirmed)

CERTIFICATE/LICENSURE
Students will be eligible to sit for the Wisconsin CNA certification exam upon successful completion of Mercyhealth Nursing Assistant Training Program

1NATP Applcation > 2Confidentiality Form > 3Review Your Entry
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Please select “Save my progress and resume later” at the end of the application if not finalized and ready to submit.

This option allows you to return to your application to update information and upload any required documents. A unique link to resume the application will be sent to your email address.

If this option is not selected, you will be unable to update your existing application, and submitting additional information will create a second application in the system.

Once your application is finalized you may submit your application.
DEMOGRAPHICS & CONTACT INFORMATION
Name Name First Last
Email

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Phone Phone - ### - ### ####
Cohort you are applying for:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
APPLICANT QUESTIONS
Why are you interested in applying to the Mercyhealth Nurse Aide Training Program?
How did you hear about this opportunity? Please select all that apply.

How did you hear about this opportunity? Please select all that apply. A Mercyhealth partner referred me to this program My family member works at Mercyhealth A previous student recommended the program Through social media Other
Name of person who referred you to our program (leave blank if non-applicable)
EMPLOYMENT HISTORY
Are you currently employed or have you previously been employed by Mercyhealth or any of its entities?

Are you currently employed or have you previously been employed by Mercyhealth or any of its entities? Yes No
If so, please indicate which department?
What was your leader's name? What was your leader's name? First Last
Are you 17 years old or older? (This is the minimum age requirement for the program)

Are you 17 years old or older? (This is the minimum age requirement for the program) Yes No (please comment below) Comments Comments
I would be interested in learning about future CNA job opportunities.

I would be interested in learning about future CNA job opportunities. Yes No Unsure at this time
DOCUMENT UPLOADS
Upload Resume (required)

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Upload SentryMD Documents (required)

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Upload Recommendation Letters (optional)

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Upload Transcripts (optional)

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College/University Name
Major/Area of Study
Graduation Date
VACCINATION RECORDS, BACKGROUND CHECK, CONFIDENTIALITY AGREEEMENT

You will use SentryMD to confidentially upload your vaccination records, background check, and confidentiality agreement.

1. Go to www.mystudentcheck.com to create your account
2. Enter "Mercyhealth Nurse Aide Training Program" in the program field
3. Choose "Immunization" under services
4. Select "Start Application"
5. Enter all fields when prompted
6. Submit payment ($29.50 fee) to complete your order

VACCINATION RECORDS:
Prospective students are required to provide documentation of the following vaccinations: MMR, varicella, Hepatitis B, Tdap, influenza, 2-step TB skin test. Two separate TB tests are required. (The second test should be administered at least 7 days after the first TB skin test)
Upload to SentryMD for review. Medical/religious exemptions can be requested.

BACKGROUND CHECK:
1 Go to https://www.dhs.wisconsin.gov/misconduct/employee.htm
2. Select "Online Background Check Request"
3. Complete the Background Information Disclosure Form F82064
4. You will be redirected https://recordcheck.doj.wi.gov/. You will be prompted to create an account
5. Before submitting your order ($15 fee), write down the order reference number to receive results
6. Upload a copy of your results to SentryMD for review

CONFIDENTIALITY AGREEMENT:
1. Review and sign the confidentiality form (page 2 of this application)
3. Upload the signed form to SentryMD for review

It takes 48-72 hours for SentryMD to review your uploaded documents.

*** Once approved as "compliant," download a PDF copy of your SentryMD records and upload here to submit with your application.
Upload SentryMD Document (required)

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ATTESTATION

I hereby authorize Mercyhealth to review my past employment, current supervisors, education, and (if required) a credit check, a driver's license check, and criminal records and release from all liability persons, companies, or corporations and institutions supplying such information. If any of the above information is found to be false or incomplete, including lack of disclosure of previous employment with Mercyhealth and its entities, that will be sufficient grounds for rejection of my application or immediate dismissal from Mercyhealth. I understand that nothing in this application is intended to imply or create an employment relationship or contract. If hired, I understand that the employment relationship is at-will and that both parties have the right to terminate the relationship at any time.
I agree with the above attestation statement.

I agree with the above attestation statement. Yes
By signing below, I verify that the information provided in this application is true to the best of my knowledge.

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I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
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A special link to resume the form will be sent to your email address.