CCHCS, SEIU Local 1000, And RCC LVN To RN Apprenticeship Program .

CCHCS, SEIU Local 1000, and RCC LVN to RN Apprenticeship Program ApplicationSeptember 2021 GuidelinesTo apply for the CCHCS, SEIU Local 1000, and RCC LVN to RN Apprenticeship Program, please completethe application and attach the following documents:1. Authorization to Obtain Prior Employment Information and review of Official Personnel File2. Written statement of interestPlease note that those applying should be prepared to begin RCC's Advanced Placement LVN to RN Nursing Program inSpring 2022 and have all admission requirements completed, including all prerequisite coursework and the HESI exam.Employee InformationName:(Last, First, MI)First 4 of SSN:Home Address:(Street)Work PhoneNumber:Address:(City, State, Zip)Cell PhoneNumber:Work EmailAddress:Institution:Employment Information 1Title/JobClassificationOrganization orInstitution:From Date:(Mo/Yr)To Date:(Mo/Yr)# Hours rvisorPhoneNumber:1

Employment Information 2Title/JobClassificationOrganization orInstitution:From Date:(Mo/Yr)To Date:(Mo/Yr)# Hours rvisorPhoneNumber:Employment Information 3Title/JobClassificationOrganization orInstitution:From Date:(Mo/Yr)To Date:(Mo/Yr)# Hours rvisorPhoneNumber:Employment Information 4Title/JobClassificationOrganization orInstitution:From Date:(Mo/Yr)To Date:(Mo/Yr)# Hours rvisorPhoneNumber:Human Resources Use OnlyDate Received:Reviewed By:2

Authorization to Obtain Prior Employment InformationAnd Review Personnel FileI,, (print name) authorize the release of information to arepresentative of the California Correctional Health Care Services (CCHCS).I understand this authorization for release of information includes the review of my officialpersonnel records and input from current/former supervisors regarding my employmenthistory, performance evaluations, probationary reports, attendance, commendations, anddisciplinary actions.Any restrictions regarding the release of information are indicated below.This information is considered confidential and shall be treated accordingly by CCHCS.This authorization is valid for one hundred and twenty (120) days.Applicant’s signatureRESTRICTIONSDate

CCHCS, SEIU Local 1000, and RCC LVN to RN Apprenticeship ProgramWritten Statement of InterestInstructions:You must submit a written statement of interest when applying to the LVN to RN apprenticeshipprogram. This statement demonstrates your ability to write clearly and concisely, and allows you toshare with readers your interest in becoming a Registered Nurse. Please respond to the followingquestions in 500 words or less:Why do you want to be a Registered Nurse for CDCR under the complete care model? How do youbelieve your role as an RN will differ from your role as an LVN?

Final Application Reminder:1. Please double check your application to ensure you have included the following requireddocuments: A signed Authorization to Obtain Prior Employment Information and Review Official PersonnelFile Written Statement of Interest2. Please submit your application packet electronically to the LVN to RN Apprenticeship Program emailbox CCHCSLVNtoRNApprenticeship@cdcr.ca.gov3. If you are unable to submit your application packet electronically, please mail it to the address below:LVN to RN ApprenticeshipProgram Attn: Kimberly ChapmanPO Box 81857Bakersfield, CA 93308Applications must be received no later than 5:00 pm on Wednesday, October 6, 2021.Submission of your Apprenticeship Application is only the first step required for apprenticeshipconsideration. The JAC will review your Apprenticeship Application to determine whether youmeet initial screening criteria. If you meet this criteria, your next step will be to apply to RCC’sAdvanced Placement (LVN to RN) ADN Program for the Spring 2022 semester. You will be advisedby the JAC when or if you need to complete this step.

2. Please submit your application packet electronically to the LVN to RN Apprenticeship Program email box . CCHCSLVNtoRNApprenticeship@cdcr.ca.gov. 3. If you are unable to submit your application packet electronically, please mail it to the address below: LVN to RN Apprenticeship Program Attn: Kimberly Chapman PO Box 81857 Bakersfield, CA 93308