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Registration Progress 25%

CNA Course Application

Step #1 of 4: Complete the Application

Fill in the form below to complete your application.

Check the CALENDAR to choose your start date.

Name(Required)

First Last

Mailing Address(Required)

Street Address City State ZIP Code

Email(Required)

Phone(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Program applying for:

NURSE AIDE I TRAINING PROGRAM

Course Preferred:(Required)

Evening Course: 6pm to 10pm, Monday thru Friday (6 Weeks)

Morning Course: 8am to 12pm, Monday thru Friday (6 Weeks)

Weekend Course: 9am to 3pm, Saturday and Sunday (10 Weeks)

Preferred Start Date:

I'm applying to this program because:(Required)

I want to work as a CNA

I need CNA certification for nursing school

I'm interested in:(Required)

Paying for the program myself so I don't have to commit to a certain employer. Payment plans available.

Applying for a work exchange program to assist with the cost of the program.

Highest Level of Education Completed:(Required)

High School or G.E.D

Associates Degree

Bachelor's Degree

Master's Degree or Higher

Do you have High School Diploma and Transcripts or High School Equivalency Certification (G.E.D):(Required)

Yes

Do you have 2 (two) forms of identification (Photo ID and Social Security Card)?(Required)

Yes

Have you ever been convicted of a misdemeanor or felony?(Required)

Yes

Are you awaiting prosecution of a misdemeanor or felony?(Required)

Yes

If yes, give details including charge(s), city, county, and state where charges occurred and year:

Do you give consent for a Criminal Background Check(Required)

Yes

How did you hear about us?(Required)

Who is your employer?(Required)

Applicant Signature:(Required)

Date(Required)

MM slash DD slash YYYY

Home
Courses
Course Calendar
APPLY!
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Home
Courses
Course Calendar
APPLY!
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Careers

4000 Blue Ridge Road, Suite 190, Raleigh, NC 27612

(919) 704-7690 school@sembranet.com