Dove Healthcare

CNA Course Application

Choose a location:

Dove Healthcare - Bloomer

Dove Healthcare - Osseo

Dove Healthcare - West Eau Claire

Dove Healthcare - Wissota Health & Regional Vent Center (Chippewa Falls)

Choose a class:

All registrations must be received by midnight on the Thursday before the class begins.

March 4 - 28 (Day) M,T,Th,F from 7AM - 3:30PM

Continue to Step 2

Choose a class:

All registrations must be received by midnight on the Thursday before the class begins.

April 29 - May 23 (Day) M,T,Th,F from 7AM - 3:30PM

Continue to Step 2

Choose a class:

All registrations must be received by midnight on the Thursday before the class begins.

	January 7 - January 25 (Day) M - F from 7AM - 3:30PM (This class is full, but you can still apply and be added to our wait list.)
	January 14 - February 22 (Evening - Weekday & Weekend Combo) Class will meet 5PM - 9PM (This class is full, but you can still apply and be added to our wait list.)
	February 4 - 28 (Day) M, T, Th, F from 7AM - 3:30PM
	February 25 - March 7 (Evening) Bridge Course Participants Only: M - F from 4PM - 9PM
	March 11 - April 19 (Evening) M,T,Th,F from 4PM - 9PM
	April 8 - May 2 (Day) M,T,Th,F from 7AM -3:30PM
	April 22 - May 31 (Evening - Weekday & Weekend Combo) Class will meet 5PM - 9PM 4/22-4/24, 5/1-5/3, 5/6-5/8, 5/14-5/17, 5/20-24, 5/28-5/31 and from 2PM -10:30PM 4/27, 4/28, 5/11, 5/12
	May 6 - 31 (Day) M,T,Th,F from 7AM -3:30PM
	June 3 - 27 (Day) M,T,Th,F from 7AM - 3:30 PM
	July 1 - 26 (Day) M,T,Th,F from 7AM - 3:30PM

Continue to Step 2

Choose a class:

All registrations must be received by midnight on the Thursday before the class begins.

	January 7 - February 7 (Evening) M-F from 4PM - 9PM (This class is full, but you can still apply and be added to our wait list.)
	February 4 - 28 (Day) M,T, Th,F from 7AM - 3:30PM
	March 4 - 28 (Day) M,T, Th,F from 7AM - 3:30PM
	April 1 - 25 (Day) M,T,Th,F from 7AM - 3:30PM
	April 1 - May 10 (Evening) M,T,Th,F from 4PM - 9PM
	May 28 - June 21 (Day) M,T,Th,F from 7AM - 3:30PM
	June 24 - July 19 (Day) M,T,Th,F from 7AM -3:30PM

Continue to Step 2

First Name:

Middle Inital:

Last Name:

Primary Phone:

Secondary Phone:

Address:

City:

State:

Zip:

Email:

Are you applying to take this class in an effort to pursue an employment opportunity with Dove Healthcare?
Yes No

Are you applying to take this class to satisfy a program requirement (i.e. nursing school)?
Yes No

Are you participating in the WisCaregiver Career Program?
Yes No

If yes, please enter your student ID

Where did you hear about this class?

Please specify

Add another referral source.

Where did you hear about this class?

Please specify

Add another referral source.

Where did you hear about this class?

Please specify

Emergency Contact Information

Contact Name:

Relationship:

Phone:

References

Name:

Relationship:

Phone:

Continue to Step 3

I verify that all the information which I have provided on this application and in resumes/exhibits is true, correct and complete. I understand that false, misleading, incomplete or omitted information will result in rejection of my application, whenever discovered. If my application is considered, I authorize an investigation and verification of all information and statements provided on this application. I release any and all persons or companies from any liability for releasing information or verifying statements on this application.

By signing and dating this form, I hereby swear all the above information is correct.

My typed first and last names below shall have the same force and effect as my written signature.

First Name:

Last Name:

Date:

Confirmation Code: