Step 1 of 12 - Personal Information
This application form is required by Title 63 O.S. § 1-1950.4 of state law and by the Oklahoma State Board of Health Rules OAC 310-2-15-3. This uniform application shall be used as the only application for employment of nurse aides in nursing and specialized nursing facilities, residential care homes, assisted living centers, continuum of care facilities, hospice programs, adult day care centers and home care agencies.
This employer does not discriminate in its hiring decisions or in any other employment decision on the basis of race, color, sex, religion, citizenship, national origin, veteran status, age or upon a physical or mental disability which is unrelated to the applicant's/employee's ability to perform the essential functions of the position.
ATTENTION NURSE AIDES: RETURN YOUR COMPLETED APPLICATION TO EMPLOYER.
For purposes of Criminal History Records Search
List your last four (4) jobs beginning with your most recent or current employer.
If you answer YES to any of the questions below, explain in the space after the question. The explanation for a YES answer should include, but not be limited to:
Please Read Carefully - If you answer 'No' to any of the questions below, explain in the space after the question.
Please complete the following if you have had CNA Training in the past for any of these categories: LTC, HH, ADC, RC, or DDDC.
It is unlawful for any person to provide false information regarding a criminal conviction on this uniform employment application for nurse aides. Providing false information regarding a criminal conviction is a misdemeanor under Title 63 of the Oklahoma Statutes, Section l-1950.4a. Providing false information about a criminal conviction on this application is punishable by a fine not to exceed Five Hundred Dollars ($500.00), by imprisonment in the county jail for a term of not more than one (1) year, or by both such fine and imprisonment.
I UNDERSTAND PROVIDING FALSE OR MISLEADING INFORMATION TO A TRAINING PROGRAM, A FACILITY, OR THE DEPARTMENT IS GROUNDS FOR DENIAL, SUSPENSION, WITHDRAWAL, AND/OR NONRENEWAL OF CERTIFICATION. I ALSO UNDERSTAND PROVIDING FALSE INFORMATION OR OMISSION OF FACTS MAY DISQUALIFY ME FROM EMPLOYMENT AND MAY CAUSE TERMINATION IF DISCOVERED AT A LATER DATE.
I certify I have read and completed this application and that the information I have provided on this application is true and complete.
Effective November 1, 2012, and in accordance with public law, Title 63 of the Oklahoma Statutes, Section 1-1950.1, employment at this employer shall not be considered if the below signed individual has been convicted of, pied guilty or no contest to, or received a deferred sentence for, a felony or misdemeanor offense for any of the following offenses in any state or federal jurisdiction, as stated by Oklahoma Statute, Section 1-1950.l(C)(l) of Title 63:
Effective November 1, 2012, and in accordance with public law, Title 63 of the Oklahoma Statutes, Section 1-1950.1, employment at this employer shall not be considered for the below signed individual if less than seven (7) years have elapsed since the completion of sentence', and the results of a criminal history check reveal that the subject person has been convicted of, or pied guilty or no contest to, a felony or misdemeanor offense for any of the following offenses, in any state or federal jurisdiction, as stated by Oklahoma Statute, Section 1-1950.l(C)(2) of Title 63:
Pursuant to 63 O.S. § 1-1950.l(A)(5), "Completion of the sentence" means the last day of the entire term of the incarceration imposed by the sentence including any term that is deferred, suspended or subject to parole.
It is further understood that if I am hired, it will be as a temporary employee until the employer receives my criminal background check. If I have no criminal record in accordance with state law, I may be considered for employment, subject to training requirements and other requirements of the job for which I am applying with this employer.
I hereby certify I have no disqualifications for employment as described above and specified in Title 63 of the Oklahoma Statutes, Section 1-1950.l(C). My signature below authorizes the employer to run a check with the Nurse Aide Registry of the Oklahoma State Department of Health for notations of abuse, neglect or misappropriation of resident's property. I hereby give the Oklahoma State Bureau of Investigation authority to proceed with a criminal history records check as authorized by Title 63 of the Oklahoma Statutes, Section 1- 1950.l(B).
Baptist Village Communities does not discriminate in its hiring decisions or in any other employment decision on the basis of race, color, sex, citizenship, national origin, veteran status, age or upon a physical or mental disability which is unrelated to the applicant’s/employee’s ability to perform the essential functions of the position.
As part of the application process, I voluntarily give Baptist Village Communities the right to make a thorough investigation of my past employment background and activities. I further agree to cooperate fully in such investigation. I hereby release from all liability and responsibility any and all persons, companies or entities which provide Baptist Village Communities with information or documents requested by Baptist Village Communities as part of the application process.
If I am hired by the company, I understand that my employment will be "at will," meaning either party - me or the company - will be able to terminate my employment at any time, with or without cause. I also understand that my employment may be terminated for any misstatement of fact appearing on, or omission of fact from, this application form.
Further, I understand that after I am given a conditional offer of employment, I may be required to undergo a physical examination as well as a background check screening as a prerequisite to my continued employment with the company. I hereby consent to take that physical examination and any such future physical examinations as are required by the company.
Finally, I understand that I, like every other employee of this company, will be required to complete an Employment Verification Form (I-9) within three (3) days of my employment. At that time, I will produce the documentation of my choosing which will satisfy the requirements stated on the I-9 form for proof of identity and eligibility for employment.
An intermediate step between residential living and assisted living. Residents living in these enhanced life neighborhoods remain independent while receiving all meals, housekeeping, and laundry service.
BVC locations with Enhanced Living services include:
(health center and memory support neighborhood)
(assisted living neighborhood)
Live comfortably in a studio, one- or two-bedroom apartment or patio home. The variety of available floor plans ensures you find the right place for your needs and you have access to many of the trusted BVC services, all with reasonable monthly service fee.
BVC locations with Residential Living include:
Residents of our Health Center receive long-term care nursing services. We also offer skilled nursing options and therapies, including physical, occupational and speech therapy, all while maintaining the feeling of home and family.
BVC locations with a Health Center include:
Having a caring, experienced place for those requiring memory support services is essential. At BVC, we ensure our neighborhoods serve the unique needs of those facing Alzheimer’s or other memory-related challenges. Two of our locations [KP5] also feature an innovative Snoezelen® room, which is a multi-sensory, relaxed environment designed to help those requiring memory support.
BVC locations with Memory Care services include:
*Location includes available Snoezelen® room
Residents and guests can experience multiple therapy options and many other amenities specifically intended to result in a speedy recovery.
BVC locations with Rehab Neighborhoods include:
Let us help you help the ones you love! Entrusted Hearts by Baptist Village is a licensed home health agency and CHAP-accredited medical equipment company. We are comprised of team members that assist you or a loved one in reaching and maintaining the highest possible level of independence at home. Personalized services are available 24 hours a day, seven days a week.
Entrusted Hearts by Baptist Village services more than 50% of Oklahoma. Contact for more information.Lawton Area: (580) 355-2440Oklahoma City Area: (405) 720-2401Owasso/Tulsa Area: (918) 272-4694
Assisted Living at Baptist Village offers a helping hand and 24-hour support. This lifestyle is an option for senior adults who need support with daily living activities or assistance managing medications and health issues.
BVC locations with Assisted Living include: