Class of 2017 CAMC Nurse Education Assistance Program

Application

Deadline:      May 16, 2014

Have your read the Frequently Asked Questions? Yes  No     If no click here.

All fields are required - Please enter "n/a" in any blank fields in order for the form to submit. 

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First Name  
Middle Initial   (NOTE: If you do not have a middle initial please put n/a in field)
Last Name
Maiden Name  
Other Last Names Transcripts may be listed under        
Street Address
City
State
Zip
Home Phone
Work Phone
Email Address
Employee ID Number (information required only if CAMC employee)
Hire Date (information required only if CAMC employee)
Hospital/Location (information required only if CAMC employee)
Department (information required only if CAMC employee)
Job Title (information required only if CAMC employee)
CAMC Employee Status   Full Time       Part-Time      Other   
Are you a spouse of a CAMC employee? Yes  No         
Are you a dependent * of a CAMC employee? Yes  No  
If  yes, complete employee information.  *Please see your benefits handbook for the definition of a CAMC dependent.
Employee Name:
Employee ID Number (information required only if CAMC employee)
Are you a legal resident of West Virginia? Yes  No  
Have you ever been employed by CAMC Health Systems, Inc. ? Yes No
How did you hear about the Nurse Education Assistance Program?
Are you an applicant with a certificate due to completing a medical/health science program, such as LPN, Medical Assisting, Nursing Assisting, Medical Coding, etc., from a vocational and technical school/career center or college?  Yes No
Are you an applicant with college credit hours?  Yes No
Did you apply for the Nurse Education Assistance Program last year?          If you submitted transcripts last year, please contact BVCTC at 304-205-6639 to make sure they still have your copy before submitting another set. Yes No
If yes to any of the above three questions, you must mail official high school, GED and/or college transcripts including copies of medical health science program certificates to CAMC Nurse Education Assistance Program Coordinator.  BridgeValley Community and Technical College - BVCTC,  Room 110F,  2001 Union Carbide Drive, South Charleston, WV 25303. All transcripts must be submitted and post marked no later than May 30, 2014.  Applications cannot be evaluated without transcript(s).
 
NOTE: To schedule for the TABE (Testings of Adult Basic Education) assessment you must choose a date from the drop down menu below. Please make a note of the date and time you are scheduled to test. Testing will be held at CAMC Memorial Hospital Campus, Robert C. Byrd Health Sciences Center. 

TABE date taken: (CAMC office use only) 
Completion of an application does not guarantee applicant will be selected to receive educational assistance. This is Step One of the selection process. Please read the Frequently Asked Questions document in its entirety.
All applicants will be notified by letter on or by June 27, 2014 regarding application status. 
Applicants for admission to Nursing must be eligible to meet requirements for licensure in the state of West Virginia as stated in the West Virginia Code. These conditions include: The Board of Examiners for Registered Professional Nurses may deny testing to any applicant proved guilty of certain infractions such as, but not limited to, fraud, felony, or moral misconduct. (See Chapter 30, Article 7, Section 11 of the West Virginia Code. If you have questions regarding licensure requirements, contact the WV Nursing Board at (304) 558-3596. 

I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions. I understand and agree that any misrepresentation in my application will be sufficient cause for cancellation of the application, and, if applicable, any educational assistance awarded. I authorize and release from liability or responsibility all persons, companies, schools and municipalities supplying any information regarding me whether or not it is a matter of record. 

*By clicking submit, I am electronically signing this document.

Attn: CAMC Employees:  I  am also confirming  that I have discussed my interest in this opportunity with my manager.