Application Form
Your Choice CNA Academy, LLC admits students of any race, color, religion, creed, gender, disability, national or ethnic origin, sexual orientation or any other category protected by applicable federal, state or local law, to all the rights, privileges, programs, and activities generally accorded or made available to students. Your Choice CNA Academy does not discriminate on the basis of race, color, religion, creed, gender (which includes a person’s actual or perceived sex, as well as gender identity and expression), age, marital status, disability, national or ethnic origin, sexual orientation, familial status, predisposing genetic characteristics, actual or perceived domestic violence victim status, unemployment status, caregiver status or any other category protected by applicable federal, state or local law, in carrying on its educational activities or in administration of its educational policies, admissions policies, employment policies, financial aid programs, and athletic and other school administered programs.

Personal Information

Section 1 - General Information

Section 2 - Drug Testing and Background Check

(Numeric Answer Only)

Section 3 - Employment Verification

Section 4 - Education

Section 5 - Other Training: Certifications/Licenses

Section 7 - Employment History

Section 8 - Reference 1

Section 9 - Reference 2

Section 10 - Emergency Contact Information

Section 11 - Consent

I certify that information contained in this application is true and complete. I understand that false information may be grounds for immediate dismissal from any and all course work, and may disqualify me from being admitted in the future. I authorize the verification of any or all information listed above.