LeadingAge California - The Gateway-In Project©

Placement Partner for Certified Nursing Assistants & Home Health Aides

Application Form

Are you interested in hiring Certified Nursing Assistants (CNA) and/or a Certified Home Health Aides (CHHA)?
The Gateway-In Project© can help! Apply now to be considered for a partnership and help hire future CNAs/CHHAs!

Questions? Please contact thegatewayinproject@leadingageca.org.

Applicant Information

First name*

Last name*

State*

Street address*

City*

Zip code*

Email*

Demographics

Which Race/Ethnicity do you identify with?*

American Indian, Native American, or Alaska Native
Asian
Black, African-American, or African
Decline to State
Hispanic, Latino/a, Spanish origin
Native Hawaiian or Pacific Islander
Not Hispanic, Latino/a, or of Spanish origin
Some Other Race
Two or More Races
White/Caucasian

Are you currently in High School? (Check box if yes. Skip if no)

What is your Highest Level of Education?*

What is your Marital Status?*

What is your Annual Household Income?*

Are you a veteran?*

Do you consider yourself to have a disability?*

How many children do you have?*

Main form(s) of transportation?**select all that apply

Carpool (shared vehicle)
Personal vehicle
Public transportation
Ride share (Lyft/Uber/etc.)
No transportation

Do you have internet access?*

Upload a headshot photo! (optional)Used for your profile. This helps us identify you during your graduation ceremony.

Employment & Background

What is your current employment status?*

Do you currently hold a CNA certification?*

Do you currently hold a CHHA certification?*

Are you currently CPR certified?*

Are you COVID-19 vaccinated?*

Are you willing to have a background check conducted?*

Are you willing to have a Physical and TB test conducted?*

Can you provide immunization records?*

Are you currently receiving alternative funding for school?*

Program Interest

What Program are you interested in joining?

Resident Service Coordinator
Activities Director
Certified Nursing Assistant

Which training program are you interested in?*

Certified Nursing Assistant (CNA)
Certified Home Health Aide (CHHA)
BOTH (Dual Certification CNA and CHHA)

How do you feel about working with older adults?*

How did you hear about us?

Employer Referral
Event (Cultural or Education)
Facebook
Google
Google Ad
Indeed
Instagram
Job Fair
LinkedIn
Newspaper Ad
Radio
School Referral
Twitter
Website
Word of Mouth
YouTube
Other
Caring4Cal Website

By completing and submitting this form you give LeadingAge California consent to keep, process, and contact as needed the provided contact information in regards to your approval and participation in The Gateway-In Project©. You may unsubscribe from these communications at anytime. For information on how to unsubscribe, as well as our privacy practices and commitment to protecting your privacy, check out our Privacy Policy.

LeadingAge California │ The Gateway-In Project© │ 1315 I Street, Suite 100, Sacramento, CA 95814
(916) 392-5111 │ thegatewayinproject@leadingageca.org