C.N.A. (NEW RATE OF PAY $17 - $18.50 Plus Shift Diff)

Email Registration

Your email address will be used as your login name allowing you to return to our website to update your profile.

If you are a returning applicant, please sign in or reset your password using the Login button.

Your Information

Save Time

Use your resume or LinkedIn Profile to fill in many of the fields on this application form.

Personal Information

How did you hear about us?

Additional Information

Have you ever been convicted of OR are you the subject of pending charges for any offense, but excluding offenses committed prior to your eighteenth birthday? If yes, Please explain below, list date of arrest, offense, identity of court, and city and state in which hearing took place for all convictions and pending charges. If no, please enter N/A.

(A conviction will not necessarily disqualify an applicant from consideration of employment.)

If you can answer YES to any of the following questions, please list each violation including date and jurisdiction. If not, please answer N/A.

Have you had a DUI or DWI conviction in the last 5 years?

Have you had a Reckless Driving conviction in the last 3 years?

Have you had more than 2 moving violations in the last 3 years? (i.e. speeding, failure to obey a highway sign etc.)

Have you had more than 1 at-fault accident in the last 5 years?

If you have ever had a founded case of child abuse against you, or you are currently the subject of a charge or investigation regarding child abuse in this state or anywhere else, please explain below. If no, please enter N/A.

Pursuant to the Federal Government, this organization may not employ or engage in a business relationship with any individual who has been suspended, excluded, debarred, or is otherwise ineligible to participate in any federal reimbursement program. Have you ever had any adverse legal actions imposed by Medicaid, Medicare, or any other federal agency or program?

Have you ever had a professional license suspended or revoked?

Have you been or are you currently under investigation by any licensing board?

Resume and Questions

Upload Your Resume

Upload your resume if you have not already done so.

Note: You can attach a total of up to 4MB of data. Your resume and all attachments combined must be less than 4MB.

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Cover Letter

You can use the text area for a cover letter and any supplementary information you would like to provide about your career goals, availability, best times to contact you, etc.


Upload any additional attachments.

Note: You can attach a total of up to 10MB of data. Your resume and all attachments combined must be less than 10MB.

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Work and Education History

Employment History

Please Include All Relevant Experience

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Education History

Add Education
Other History

Certificates and Licenses

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Review and Submit

Applicant's Agreement, Certification, and Release


I certify that the information I have provided on this application and any accompanying resume and documents, if any, is true and complete to the best of my knowledge. I have not knowingly withheld any information that might, if disclosed, affect my application unfavorably. I understand that any false or misleading statements provided by me, either written or verbal, may be cause for denial or termination of employment.

As part of my application for employment at Grafton, I authorize and consent to the release of any information of any nature concerning me including, but not limited to, my present or previous employment, educational records, educational credit verification, personal and professional reference data, credential verification, information concerning my driver’s license and driving record, any criminal record checks, any Child Protective Services registry checks, drug screening information, and any other similar data.

I authorize the giving of any such information to the employees and agents of Grafton, and I authorize all of my employers, my reference individuals and any other entities which have information about me to respond to any question and to provide all oral or written information concerning me. Grafton may use a copy of this authorization as deemed necessary, which copy shall operate as if it were an original.

I understand that only a member of the Human Resources department of Grafton has authority to make an offer of employment to me. I further understand that any offer of employment is conditional upon results satisfactory to Grafton of the screening, record checks and investigations listed above in the second paragraph.

I understand that Grafton has broad discretion whether or not to hire me. I agree that, if hired, my employment will be “at will” for no definite period, and may be terminated at any time by either me or Grafton. In addition, I understand that Grafton has the right to change, modify or terminate its personnel policies, practices, benefits and other terms of employment, at any time.

I release Grafton, its agents, and all entities who provide information as a result of this agreement, from all liability of any nature arising out of the disclosure, use, or review of any information given as a result of this agreement.

By typing my name below I acknowledge and agree to the above statements.

Candidate Sign Off

I certify that all of the information in this application is true and correct as of this date.

Application Review