| Northwest Senior Management Services |
| Employement Opportunities, Access Care , Etc ... |
| Training and Experience Click all that apply: |
| Car, Insurance and Driver's license Click all that apply: |
| Your Work Preferences Click all that apply: |
| In what area are you willing to work? |
| I am at least 18 years and older. |
| I am a Cerified Nuring Assistant (CNA). |
| I have a current CNA certificate. |
| I have at least ONE years experience in a facility setting, under a RN's supervision. |
| I have a valid Oregon driver's license. |
| I have a valid Washington driver's license. |
| I have a reliable car. |
| I have a current auto insurance policy. |
| Clackamas Country |
| Multnomah Country |
| Washington Country |
| Are you willing to work a three hour shift? (Our minimum shift is 3 hours.) |
| Will a CRIMINAL background check reveal any issues? |
| Will a Driver's license check reveal any issues? |
| We reserve the right to do random drug testing. Do you have any issues this? |
| Background Check: |
| Thank you for completling this form. Please 'SUBMIT' this form and we will contact you for an application form. |
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