CNA Interview Questionnaire

What is your full name?

What is your phone number?

What is your Email address?

What City/State are you applying for?

How many years of CNA experience do you have?

Less than 1 year

Less than 2 years

2-5 years

5+ years

What areas of experience do you have? Choose all that apply.

Hospital

Med-Surg

ICU

Rehab

Home Health Care

Nursing Home

How many years of hospital experience do you have as a CNA?

1 Year

2 Years

More Than 2 Years

Do you have a current valid State license as a CNA/STNA for the state you are applying for?

Yes

No

Do you have valid BLS certification through AHA, ARC or AMRI

Yes

No

I do not, but I am willing to get it

Which shift are you interested in? Day shift is 7a-7p, Night shift is 7p-7a

Day Shift: 7a-7p

Night Shift: 7p-7a

I am open to either shift

What kind of contract are you looking for?

8 week Full Time contract

13 week Full Time Contract

I am only available for PRN at this time

What is your available start date?

Do you have any dates that you cannot work/time off requests?