EMT Associates NA Applications

NA Training Application - EMT Associates

Long-Term CareWorks offers a no-cost, sponsored nursing assistant (NA) training program through EMT Associates in Myrtle Point, Oregon. This program provides expert instruction, mentorship, and meaningful financial support on your path to employment in long-term care.
Contact and Demographic Information
Legal Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
Social Security Number*
We use this for the background check. A valid SSN is required to take the CNA exam in Oregon. If you don't have one, please reach out to us.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
homecare workerpersonal support workerpersonal care attendantNo
YesNo
How did you hear about this program?*
I understand that the goal of this program is for me to work as a CNA in one of our partnered, unionized long-term care facilities after completing my training and receiving OSBN certification.
YesNo

Minimum Requirements to participate

Each applicant must meet the minimum requirements of EMT Associates' training program to be considered as a candidate.
YesNo
YesNo
YesNo
Attendance Requirements
This is a fast-paced program. Due to this short timeline, there will be no makeup days available. This means you may not miss any portion of class over the 4 weeks.

Students are responsible for attending in-person classes, labs, and clinicals from Monday, May 4 through Friday, June 5

Dates and times for clinicals are assigned once students are enrolled and the schedule is finalized.

If you have any prior commitments during this time frame that you aren't able to miss, we ask that you keep this program in mind to join at a later date.

Please note: Program schedule is subject to change
YesNo

CNA Duties and Responsibilities
YesNo
YesNo
Facilities generally schedule CNAs on a 4 on, 2 off rotation. This means you could work Mon-Thu and have Fri-Sat off one week, then work Sun-Wed and have Thurs-Fri off the next week.
YesNo
6am-2pm2-10pm10pm-6am

Wraparound Support needs assessment

Long-Term CareWorks is committed to identifying and addressing obstacles that make it challenging for learners to finish and excel in our CNA training programs. The following questions will help us understand how we can better serve you if you're chosen to participate in our program.
Are there any obstacles that might make it difficult for you to fully participate in CNA training and job placement? If so, please list below. Obstacles may include reliable transportation, secure housing, food access, childcare, etc.*
YesNo
YesNo
YesNoNot applicable
YesNo
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NA Training Application - EMT Associates