css health services
 

Employment

Providing companionship, personal care, and skilled nursing services for Metro-Atlanta and surrounding counties.

CSS Healthcare Services maintains vigorous quality assurance program that ensures our clients receive high caliber professional care. All of our nurses and nurse aides are State licensed and CPR/First Aid certified. Each applicant to our organization undergoes a thorough background check before they are employed. All caregivers receive refresher courses every quarter during in-service training this helps to ensure that there are no deficiencies in their abilities. In addition, they receive annual performance evaluation centered on skills competencies and customer satisfaction.

HIRING PRACTICES:

CSS Healthcare Services is an equal opportunity employer. The Agency does not discriminate with respect to hiring, firing, compensation, and all other terms and conditions of privileges of employment on the basis of race, color, national origin, ancestry, sex, marital status or religious creed. We are committed to providing opportunities for all eligible and/or qualified persons.

CNA APPLICATION

Your work Availability

Check off the time frame(s) that you are available

*Please call and update us if your availability changes*

  MON TUE WED THU FRI SAT SUN
7am - 3pm
3pm - 11pm
11pm - 7am

Date Available for Work:

Certification:
RN: LPN: CNA: Other:

Email Address: Date of Birth (MM/DD/YY):

Name County of Residence:
Current Address City:
State: ZipCode:
Home Phone Alternate Number
- - - -
Permant Address City
State ZipCode
 
Can you provide proof of eligibility to work in the United States?: Yes    No Have you been arrested?: Yes    No
 

Have you ever been convicted of a felony other than a misdemeanor, or traffic violation?
Yes      No     If yes, Explain:
 
Emergency Contact: Phone #
- -

Education:   Highschool
NAME Address
City State / Zip
DATES ATTENDED GRADUATED
From: TO: Yes No
COURSES/MAJOR  
 

VOCATIONAL/ TECHNICAL
NAME Address
City State / Zip
DATES ATTENDED GRADUATED
From: TO: Yes No
COURSES/MAJOR
 

COLLEGE/ UNIVERSITY
NAME Address
City State / Zip
DATES ATTENDED GRADUATED
From: TO: Yes No
COURSES/MAJOR
Prior Work Experience (At Least 5 Years)
   
Present or Previous Employer Address
City State / Zip
Phone Job Titles
- -
Supervisor Dates Worked
From: TO:
Salary Duties
$    Hrs   Weekly
Reason for Leaving:  
   
 
Present or Previous Employer Address
City State / Zip
Phone Job Titles
- -
Supervisor Dates Worked
From: TO:
Salary Duties
$    Hrs   Weekly
Reason for Leaving:
   
   
Present or Previous Employer Address
City State / Zip
Phone Job Titles
- -
Supervisor Dates Worked
From: TO:
Salary Duties
$    Hrs   Weekly
  Reason for Leaving:

   
Pre-Employment Interview
   
How long have you worked as a CNA: Yrs. Months
   
What type of facilities have you worked in.(check your answers)
**Hold down the Ctrl Key On Keyboard to select more than 1 item
   
What type of Clients have you worked with:(check your answers):
**Hold down the Ctrl Key On Keyboard to select more than 1 item
 
Have you ever been fired from a Job?
Yes No If Yes give reason.
   
Have you ever quit a job?  
Yes No If Yes give reason:
   
Do you think that you will be confident in going to a client's home and perform your assigned duties in a professional manner without further training?: Yes No

If no please list additional training you will need:
   
Have you ever cooked for client before and what type of meals have you made?
   
Are you afraid of working in a house where there are pets?: Yes No
   
List all languages that you speak (native and Foreign):
   
 
 
   
     
  Copyright © CSS HEALTHCARE SERVICES 2010 |  Questions? Call: 770-210-0631