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Scholarship Program Questionnaire
Get a FREE CNA training program at Northern California Nursing Academy and start working at Pacific Heights Transitional Care!
Please complete the questionnaire below to sign up.
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* Indicates required question
First and Last Name
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
City of Residence
*
Your answer
Are you at least 18 years old?
*
Yes
No
Required
Have you completed a CNA training program and passed the CNA Exam (NNAAP Exam)?
*
Yes
No
Are you available to work a minimum of 32 hour per week, including at least 2 weekends a month?
*
Yes
No
Are you available to work on major holidays including the days before and after a major holiday?
*
Yes
No
Are you available to work:
- AM shift, 7:00 am to 3:30 pm
- PM shift, 3:00 pm to 11:30 pm
- NOC/Night shift, 11:00 pm to 7:30 am
*
AM (6:45am to 3:15pm)
PM (3:00pm to 11:30pm)
Night (11:00pm to 7:30am)
Required
What is your current COVID-19 vaccination status?
*
Not yet vaccinated
Fully vaccinated with initial series but no booster
Fully vaccinated with initial series and a booster
Other
Are you able to provide work authorization upon employment?
*
Yes
No
What is the best time to reach you for a follow up?
*
Please select ALL that apply. If "Other" please specify date(s) & time(s).
Weekday Mornings
Weekday Evenings
Weekends Mornings
Other:
Required
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