Tri-Parish Works/Slidell Memorial Hospital and Ochsner North Shore - Workforce Development Eligibility Pre-screening

Eligibility Pre-screening

If you have a great attitude and attention to detail, Slidell Memorial Hospital and Ochsner are willing to train you on-the-job in the healthcare field. This is made possible through funding assistance from Tri-Parish Works.

Your answers to these questions will help us determine if you meet initial criteria for the on-the-job training program, and may include assistance for uniforms, child care assistance, or transportation reimbursement while you get started. If eligible, we can even help fund tuition should you decide to advance your healthcare career later on.

Please complete ALL questions with accurate information so that we may determine your eligibility and fit for the On-the-Job Training program. If you are likely to be eligible based on your answers, you will be contacted to provide additional documentation to verify your eligibility.

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* 1. Please provide the following contact information

First Name *

Last Name *

Primary Phone Number: *

Email Address that is checked often: *

Phone Number that is available to receive Text Message:

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* 2. Which occupation are you interested in pursuing?

Disinfection Technician - more than just cleaning its the "first defense" with respect to infection control. Creating a clean and safe facility builds a confidence in the hospitals services and translates into improved patient satisfaction.

Nursing Assistant - Hospital certified nursing assistants have the extraordinary opportunity to make a positive impact in the lives of their patients. By aiding the nursing staff in nearly every aspect of patient care, hospital CNAs play a significant role in a patient's day-to-day experience within a healthcare facility.

Food Service Worker- Food Service employees serve has a direct, beneficial and healthy impact on patients. Good nutrition plays a major role in not only staying healthy, but also recovery from a medical procedure, injury or illness.

PRN Sitter- If you're looking for a full-time job in the hospital and can't find one, a PRN job can help you get your foot in the door. PRN Sitters provides direct patient care to support the licensed professional nurses. They work "as the situation demands" or only when the hospital needs you.

Other (please specify)

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* 3. Are you currently working?

I am not currently working

I am currently working full-time (more than 30 hrs a week)

I am currently working part-time

I'm not working now, but have worked in the past

If you are currently working, what is your hourly rate of pay?

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* 4. Please answer the following questions to assist us in determining your eligibility. Please answer each question carefully and accurately.

	Yes	No
Are you receiving unemployment benefits?	Are you receiving unemployment benefits? Yes	Are you receiving unemployment benefits? No
Did your previous employer close or go out of business?	Did your previous employer close or go out of business? Yes	Did your previous employer close or go out of business? No
Did you work less than 20 hours a week in your last job?	Did you work less than 20 hours a week in your last job? Yes	Did you work less than 20 hours a week in your last job? No
Was your last employer a temporary employment agency?	Was your last employer a temporary employment agency? Yes	Was your last employer a temporary employment agency? No
Do you or someone in your household receive Food Stamps (SNAP)?	Do you or someone in your household receive Food Stamps (SNAP)? Yes	Do you or someone in your household receive Food Stamps (SNAP)? No
Are you not likely to return to your previous occupation with the skills you currently have?	Are you not likely to return to your previous occupation with the skills you currently have? Yes	Are you not likely to return to your previous occupation with the skills you currently have? No
Do you or someone in your household receive Welfare Assistance (TANF)?	Do you or someone in your household receive Welfare Assistance (TANF)? Yes	Do you or someone in your household receive Welfare Assistance (TANF)? No
Do you have a high school diploma or it's equivalent?	Do you have a high school diploma or it's equivalent? Yes	Do you have a high school diploma or it's equivalent? No
Do you have a disability?	Do you have a disability? Yes	Do you have a disability? No
Are you pregnant or parenting and between the ages of 16-24?	Are you pregnant or parenting and between the ages of 16-24? Yes	Are you pregnant or parenting and between the ages of 16-24? No
Are you between the ages of 16-24?	Are you between the ages of 16-24? Yes	Are you between the ages of 16-24? No

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* 5. I certify that the information provided is true and accurate to the best of my knowledge. Please enter today's date

Today's date:

Date

Thank you for completing the pre-eligibility application. If you are determined eligible you will be contacted by your local Business and Career Solutions Center to complete your application and provide the following documentation:
> Valid Driver's License or State ID
> Social Security Card
> If a male over the age of 18, Selective Service verification
> Additional documentation to verify eligibility will also be requested

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* 6. Please register or update your information in HiRE at www.LouisianaWorks.net. The more updated and complete this information is, the more quickly we can process your eligibility determination. Even if you are not eligible, registering in HiRE will give you a head start in finding that future career that you have always wanted.

Please tell us about your career interests to help us better understand your needs. Also, feel free to let us know if you have any questions or concerns that you would like to have answered by a staff member of Tri-Parish Works.

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* 1. Please provide the following contact information

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* 2. Which occupation are you interested in pursuing?

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* 3. Are you currently working?

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* 4. Please answer the following questions to assist us in determining your eligibility. Please answer each question carefully and accurately.

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* 5. I certify that the information provided is true and accurate to the best of my knowledge. Please enter today's date

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* 7. Please write in a paragraph why you want to work for Slidell Memorial Hospital and why you think healthcare support occupations are important.