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CNA and PCA'S Position

In Home CNA/Home Health Aides. Hiring for all shifts and 24-hr.live-in's. Join us in helping Wake and Durham County residence remain in the comfort of their homes!

 

Are you a national or regional company looking to establish a relationship with Trinity? Contact
Tracey Gardner, Assistant Directorr or call 919.771.6692

Apply Online
First Name* Middle Name * Last Name * Maiden Name Other Last Name(s)
Address City * State * Zip * Social Security Number
Home Phone * Mobile Phone * Work Phone Email *  
 
Are you at least 18 years of age? *
Yes No
How did you hear about us
*
I am available to work
  Mon Tues Wed Thurs Fri Sat Sun
Morning
Noon's
Evenings
Nights
My availability above is flexible
Ideal # of hours I'd like to work per week*
Yes No I can work Live Ins
Yes No I can work with dogs
Yes No I can work with cats
Yes No I can work with clients who smoke
I'm available to work in the following cities/areas

 
If hired, can you provide proof of citizenship or employment authorization?
Yes No   If "no", please explain:
Have you ever been convicted of a felony? (A conviction is not an automatic bar from employment)
Yes No   If "yes", please explain:
Have you ever been convicted of a drug, assault, or theft related misdemeanor? (A conviction is not an automatic bar from employment)
Yes No   If "yes", please explain:
Have you ever been in a medical-professional liability suit within the last five years?
Yes No   If "yes", please explain:
Has your license/certification ever been suspended or revoked?
Yes No   If "yes", please explain:
Education
  Name, City, State Years Attended Degree/Cerificate Did you graduate?
High School Yes No
Nursing/Tech School Yes No
College Yes No
Post-College Yes No
Other Training Yes No
Professional Affiliations/Organizations
Name/Type Member Number Exp. Date
Past Employment
Company or Facility Type of Business
Address: City: State: Zip:
Supervisor Name Phone Salary/Pay Rate Dates of Employment
to
Reason For Leaving Specialty Experience

Company or Facility Type of Business
Address: City: State: Zip:
Supervisor Name Phone Salary/Pay Rate Dates of Employment
to
Reason For Leaving Specialty Experience

Company or Facility Type of Business
Address: City: State: Zip:
Supervisor Name Phone Salary/Pay Rate Dates of Employment
to
Reason For Leaving Specialty Experience
Licenses/Certifications Other Certification(s)
Type State License/Cert. Number Exp. Date Active
Type
 Exp. Date
Yes No
Basic Life Support
Yes No
Advanced Cardiac Life Support
Yes No
CPR
Yes No
First Aide
Yes No Other
Additional Work Related References
(1) Individual’s Name:
Company Name:
Your relationship to reference:
Telephone Number of reference:
Other telephone:
Email address:
Mailing Address:


(2) Individual’s Name:
Company Name:
Your relationship to reference:
Telephone Number of reference:
Other telephone:
Email address:
Mailing Address:


(3) Individual’s Name:
Company Name:
Your relationship to reference:
Telephone Number of reference:
Other telephone:
Email address:
Mailing Address:


Comments/Questions:
 


* Required information to submit form.

Trinity Staffing, Inc
2129 Corporation Parkway
Raleigh, NC
email: info@trinitystaffinginc.com
© 2009 - Trinity Staffing, Inc.- Providing In Home Care & Assistance.