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U ^ /h > } o í ì ì ì U v Z >sE } ZE€¦ · 9/11/2020 · , ^ U ^ /h > } o í ì ì ì U v Z...
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APPRENTICESHIP PROGRAM APPLICATION Guidelines To apply for the CCHCS Apprenticeship Program, please complete the application and attach the following documents: 1. Authorization to Obtain Prior Employment Information and Review Personnel Folder 2. LVN to RN Prerequisite Courses and Riverside City College (RCC) Advanced Placement (AP) Exam Checklist Form 3. Copy of RCC AP Exam, if completed 4. Copy of unofficial transcripts 5. Written Statement of Interest Employee Information NAME (FIRST MI LAST NAME) LAST FOUR OF SSN MAILING ADDRESS CITY STATE ZIP CODE EMAIL HOME/CELL NUMBER INSTITUTION WORK PHONE NUMBER EXTENSION Employment History FROM DATE TO DATE TITLE AND/OR JOB CLASSIFICATION # OF HOURS PER WEEK ORGANIZATION AND/OR INSTITUTION NAME SUPERVISOR INFORMATION NAME PHONE NUMBER EXTENSION EMAIL ADDRESS
Transcript of U ^ /h > } o í ì ì ì U v Z >sE } ZE€¦ · 9/11/2020 · , ^ U ^ /h > } o í ì ì ì U v Z...
//I/{Σ {9L¦ [ƻŎŀƭ млллΣ ŀƴŘ w// [±b ǘƻ wb
APPRENTICESHIP PROGRAM APPLICATION
GuidGuidelines
To apply for the CCHCSΣ {9L¦ [ƻŎŀƭ млллΣ ŀƴŘ w// [±b ǘƻ wb Apprenticeship Program, please complete the application and attach the following documents:
1. Authorization to Obtain Prior Employment Information and Review Personnel Folder 2. LVN to RN Prerequisite Courses and Riverside City College (RCC) Advanced Placement (AP) Exam
Checklist Form 3. Copy of RCC AP Exam, if completed 4. Copy of unofficial transcripts 5. Written Statement of Interest
Employee Information
NAME (FIRST MI LAST NAME) LAST FOUR OF SSN
MAILING ADDRESS CITY STATE ZIP CODE
EMAIL HOME/CELL NUMBER
INSTITUTION WORK PHONE NUMBER EXTENSION
Employment History
FROM DATE TO DATE TITLE AND/OR JOB CLASSIFICATION
# OF HOURS PER WEEK ORGANIZATION AND/OR INSTITUTION NAME
SUPERVISOR INFORMATION NAME PHONE NUMBER EXTENSION
EMAIL ADDRESS
2
Employment History (Cont.)
FROM DATE TO DATE TITLE AND/OR JOB CLASSIFICATION
# OF HOURS PER WEEK ORGANIZATION AND/OR INSTITUTION NAME
SUPERVISOR INFORMATION NAME PHONE NUMBER EXTENSION
EMAIL ADDRESS
FROM DATE TO DATE TITLE AND/OR JOB CLASSIFICATION
# OF HOURS PER WEEK ORGANIZATION AND/OR INSTITUTION NAME
SUPERVISOR INFORMATION NAME PHONE NUMBER EXTENSION
EMAIL ADDRESS
FROM DATE TO DATE TITLE AND/OR JOB CLASSIFICATION
# OF HOURS PER WEEK ORGANIZATION AND/OR INSTITUTION NAME
SUPERVISOR INFORMATION NAME PHONE NUMBER EXTENSION
EMAIL ADDRESS
Human Resources Use Only
DATE RECEIVED REVIEWED BY
Authorization to Obtain Prior Employment Information And Review Personnel File
I, , (print name) authorize the release of information to a representative of the California Correctional Health Care Services (CCHCS). I understand this authorization for release of information includes the review of my official personnel records and input from current/former supervisors regarding my employment history, performance evaluations, probationary reports, attendance, commendations, and disciplinary 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 signature Date
RESTRICTION
1
CCHCS, SEIU Local 1000, and RCC LVN to RN Apprenticeship Program Prerequisite/GE Courses and Riverside City College AP Exam Form
Prerequisite Courses: Please thoroughly complete this form identifying all RN prerequisite
coursework you are currently taking or have previously completed.
Please note that all applicants must also submit unofficial copies of their college transcripts with their apprenticeship application (a computer printout of your records will also suffice). These transcript copies should validate completion of any prerequisites. Coursework that is “in progress” should also be identified. If the coursework was not completed at Riverside City College (RCC), it must have been have been successfully completed at an accredited college, transferrable to RCC, and equivalent to the coursework below. (You may consult the RCC College Catalog to review course descriptions.)
Name: _________________________________________________ Date: ______________
RCC AP ADN Prerequisite Equivalent Course Title College Grade Completion
Date (Mo/Yr)
NURSING 18 and LAB: LVN to RN Transition Course
for AP Students
N/A (Must be taken
at RCC)
N/A (Must be taken
at RCC)
BIO 50A: Anatomy and Physiology 1
BIO 50B: Anatomy and Physiology 2
BIO 55: Microbiology
One of:
1 Semester College Chem (i.e. CHEM 2A or 3)
Verification of 3, 4, or 5 on AP CHEM Exam
PSYCH 9: Developmental Psychology
2
Prerequisite/GE Courses and Riverside City College AP Exam Form (Cont.)
General Education Requirements: The following general education courses are not required for
admission to the RN Program; rather, they are required for the completion of the Associate in Science
Degree in Nursing. Most students complete these requirements before entering the RN Program due
to the rigorous nursing student course load.
GE Requirement Equivalent Course
Title College Grade
Completion Date (Mo/Yr)
English Composition ENG 1A/1H
American Institutions HIS 6, 6H, 7H, 8, 9, 15, 26, 29, 30, 31, 34, 53; POLI-SCI 1, 5
Social and Behavioral Sciences
SOC 1 or ANTH 2
Communication and Analytical Thinking
COMM 1 or 9; And one of:
MATH 12, MATH 12H, or PYSCH/SOC 48
Humanities See RCC Catalog
1. Do you have a minimum GPA of a least 2.5 in all General Education Courses? ☐ Yes ☐ No
2. Do you have a cumulative GPA of a least 2.0 in all work attempted at RCC? ☐ Yes ☐ No
Riverside City College AP (HESI) Exam: If you have taken the RCC AP Exam, please list your
exam results below. Please identify the version the date of the exam, and your score.
Date (Month/Year) Score
CCHCSΣ {9L¦ [ƻŎŀƭ млллΣ ŀƴŘ w// LVN to RN Apprenticeship Program
Written Statement of Interest
Instructions:
You must submit a written statement of interest when applying to the LVN to RN Apprenticeship program. This statement demonstrates your ability to write clearly and concisely, and allows you to share with readers your interest in becoming a Registered Nurse. Please respond to the following questions in 500 words or less:
Why you want to be a Registered Nurse for CDCR under the complete care model? How do you believe 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 required documents:
☐Authorization to Obtain Prior Employment Information and Review Personnel Folder
☐LVN to RN Prerequisite/GE Courses and Riverside City College AP Exam Checklist Form
☐Copy of Riverside City College AP (HESI) Exam Scores, if exam has been completed
☐Copy of unofficial transcripts
☐Written Statement of Interest
2. Please submit your application packet electronically to the LVN to RN Apprenticeship Program email
3. If you are unable to submit your application packet electronically, please mail it to the address below:
LVN to RN Apprenticeship Program Attn: Cleo Luna PO Box 81857
Bakersfield, CA 93380
Applications must be received no later than
5:00 pm on Friday, October 9, 2020.
Submission of your Apprenticeship Application is required for placement on the ranked applicant
list, but it is only the first step required for apprenticeship consideration. Prior to apprenticeship
selection, highly ranked applicants will need to apply to RCC’s Advanced Placement (LVN to RN) ADN
Program and receive acknowledgement of acceptance. You will be advised by the JAC when or if
you need to complete this step.
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