Certified Nursing Assistant Program Application

To enroll in BRIDGES Certified Nursing Assistant program, please read the program information below and then fill out and submit the electronic application that follows.

BRIDGES USA, Inc. is authorized for operation as a postsecondary educational institution by the Tennessee Higher Education Commission. In order to view detailed job placement and graduation information on the programs offered by BRIDGES, please visit www.state.tn.us/thec and click on the Authorized Institutions Data button.

Program cost - $2,100

Tuition vouchers for the class may be issued by the Memphis Area Career Center or Department of Human Services (referred to as the student's funding/sponsoring agency). Students may have up to three days of the first week of class to obtain their voucher unless the funding/sponsoring agency required them to obtain the voucher before enrolling or the first day of class. If a student is not able to obtain a voucher from a funding/sponsoring agency, they may pay the same tuition fee for the training program (in this case, $2,100). The full tuition amount must be received by the fifth class day and must be in the form of a money order, cashier's check or loan check from a financing agency. Books and basic class supplies are provided by BRIDGES USA, Inc. for use during the class. There is a $100 non-refundable application/registration fee included in the tuition cost, however, this fee is not required at the time of application.

Transferability of Credit

Credits earned at BRIDGES may not transfer to another educational institution. Credits earned at another educational institution may not be accepted by BRIDGES. You should obtain confirmation that BRIDGES will accept any credits you have earned at another educational institution before you execute an enrollment contract or agreement. You should also contact any educational institutions that you may want to transfer credits earned at BRIDGES to determine if such institutions will accept credits earned at BRIDGES prior to executing an enrollment contract or agreement. The ability to transfer credits from BRIDGES to another educational institution may be very limited. Your credits may not transfer and you may have to repeat courses previously taken at BRIDGES if you enroll in another educational institution. You should never assume that credits will transfer to or from any educational institution. It is highly recommended and you are advised to make certain that you know the transfer of credit policy of BRIDGES and any other educational institutions you may in the future want to transfer credits earned at BRIDGES before you execute an enrollment contract or agreement.

First Name:
Last Name:
Social Security Number:
Address:
City:
State:
Zip Code:
Telephone:
Cell Phone:
Emergency Contact Name:
Contact's Telephone:
Are you on Families First?
If Yes, Case Worker's Name:
Phone Number:
Type of transportation voucher:
Do you live in Section 8 Housing?
Number of Children:
Ages of Children:
Child care plans when employed:
Transportation plans when employed:
Do you have a valid driver's license?
Expiration Date:
Marital Status:
Date of Birth:
Sex:
Race:
Do you have:
Name of High School:
Last Grade Completed:
College/Vocation School:
Major:
# Credits:
Have you ever been arrested in TN or any other state?
If yes, when?
If yes, reason?
Will you consent to a criminal background check?
Will you consent to a drug test?
Have you applied at BRIDGES before?
Name of employment counselor at BRIDGES:
.
Employment History:
.
Name of Company:
Dates Employed:
Title:
Salary/Hour:
.
Name of Company:
Dates Employed:
Title:
Salary/Hour:
.
Name of Company:
Dates Employed:
Title:
Salary/Hour:
.
Please list any special skills, licenses, or certifications which you possess:
Do you have any prior training or experience as a Nursing Assistant?
Are you presently CERTIFIED as a Nursing Assistant?
List two references (Former employers preferred, but personal references are acceptable):
Name:
Telephone:
Relationship to you:
.
Name:
Telephone:
Relationship to you:
.
What salary to you expect to make as a CNA? (per hour)
Where would you like to work?
Type of work desired:
What shift would you like to work?
Are there any days of the week that you cannot work?
Following graduation, do you plan to:
Have you lived in another state besides TN?
If Yes, what state?
By typing my name, I certify that all information I have given is true. I understand
that providing false information is grounds for termination from this program.

Please answer the simple math question below to submit the form.

2 + 2 =

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