Pre-Employment Screening Form

Our starting salary is $9.00 per hour for CNA’s and $10.00 per hour for PCT’s.

We also offer a $1.00/hour shift differential for night (7P-7A) and weekend shifts.

All fields required, unless indicated.

Check the box to verify that you have, in your possession, the original of each document below. Must include expiration date for each.

If you do not have ALL of these documents, please stop here. We are not able to schedule an interview if any of these is missing. After you have secured all current original items listed, return to this page and complete this form.

Please include the number of years and/or months

Have you applied or worked with us before? If yes, when?

Please indicate what days and general time ranges you would be available to accept assignments.

You’ll be asked to provide more specific times during the hiring process.