Med Aide II

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• Part Time (40 hours/2 weeks) 6:00am-2:30pm

*ND CNA required

*ND Med Aide II required (please inquire with ND Department of Health for more info on becoming a Med Aide)

*Must be 18 years of age or older

*Bethany offers an attractive benefits package including health, dental and vision insurance, paid time off, extended sick time, longevity bonus, anniversary bonus, 401(k) with a generous employer match and a corporate wellness program.

Bethany Retirement Living is an equal opportunity / affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Apply now!

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Your Name *
First Last

Your Email Address *

Your Phone *

Address *
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How did you learn of this opening? *

Sunday Fargo Forum

Employee Referral

Job Service

Jobs HQ

Valley News Live Employment

Career Builder

Other

If it was a Referral - May We Ask Who?

Campus *
--- University 42nd Street Either

Position Desired *

RN/LPN

CNA

Dining Services Assistant

Community Life Assistant (Activities)

Basic Care Med Aide

Scheduling Clerk

Clinical Dietitian

Restorative Aide

Housekeeping

Assisted Living CNA

Assisted Living Nurse

Medication Aide II

Medication Nurse

Other

Hours *

Full Time

Part Time

As Needed / On-Call

Any Available

Specify the times for each day that you are available to work: *

Sat

Sun

Mon

Tues

Wed

Thurs

Fri

Were you previously employed by Bethany? *
--- Yes No

If so, when?

Are you eligible to work in the United States? *
--- Yes No

If you have ever been employed or attended school under another name, list other name(s) used:

Are you at least 16 years of age? *
--- Yes No

Do you have an Employment & Age Certificate?
--- Yes No

Have you ever performed Nurse Assistant duties or been listed on a state registry and/or licensing board?
--- Yes No

In order to check Abuse Registries, please list all states in which you have been registered

Have you ever been convicted of an offense (including felonies and misdemeanors i.e. DUIs, insufficient funds, minors in consumption and convictions removed from record), excluding minor traffic violations? *
--- Yes No

Explain

Have you ever been found guilty by a court of law of abusing neglecting or mistreating a resident or of misappropriate of their property? *
--- Yes No

Explain. Include dates, places, charges, and results. Disclosure of information will not necessarily bar you from consideration for employment and will only be considered in relation to specific job requirements. Age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into consideration. Under federal regulations, however, conviction of resident abuse, neglect or mistreatment or misappropriation of resident property will disqualify you from consideration for employment.

For anyone who has worked as a CNA: Have you ever had a nurse aide registry listing or certification marked for abuse or negligence?
--- Yes No

For anyone who has worked as a RN or LPN: Have you ever been investigated by a Board of Nursing?
--- Yes No

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Education & Licenses
Currently Enrolled In:

High School

College

CNA Class

Not Enrolled

Did you graduate?
No High School College

If required for this position, indicate License, Registration, or Certification Information (Ex: CNA, RN, LPN, Pharmacy, etc.)

Type
License Registration Cert

License Address
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State

Number

Expiration Date
MM slash DD slash YYYY

CNAs: If still in class, when is your test date?

Month 1 2 3 4 5 6 7 8 9 10 11 12

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920

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Work Experience
Beginning with your most present or most recent employment (regardless of length of time), list all periods of employment and unemployment including military service assignments and volunteer activities.

Previous Employment
Company 1 *

Company

Supervisor's Name & Title

Company Address *
City Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State

Company Phone Number *

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To
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Your Title

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Reasons for Leaving

Ending Salary

If currently employed, may we contact them?
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Company 2

Company

Supervisor's Name & Title

Company Address
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To
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Your Title

Description of Duties

Reasons for Leaving

Ending Salary

If currently employed, may we contact them?
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Would you like to add more Previous Employers?

Yes

No

Company 3

Company

Supervisor's Name & Title

Company Address
City State / Province / Region

Company Phone Number

From
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To
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Your Title

Description of Duties

Reasons for Leaving

Ending Salary

If currently employed, may we contact them?
--- Yes No

Would you like to add more Previous Employers?

Yes

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Company 4

Company

Supervisor's Name & Title

Company Address
City State / Province / Region

Company Phone Number

From
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To
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Your Title

Description of Duties

Reasons for Leaving

Ending Salary

If currently employed, may we contact them?
--- Yes No

Would you like to add more Previous Employers?

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Personal Reference 1 *

Name

Phone Number

How does this person know you?

Personal Reference 2

Name

Phone Number

How does this person know you?

I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I further understand that I am required to abide by all rules and regulations of the facility.

Signature of Applicant

Bethany Retirement Living is an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, sexual orientation, gender identity, protected veteran status, or any other characteristic protected by law.

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Bethany Retirement Living is an Equal Opportunity Employer
201 University Dr. S., Fargo, ND 58103
(701) 239-3000

APPLICANT DISCLOSURE AND RELEASE FOR BACKGROUND CHECKS, DRUG SCREENING, AND REFERENCE INFORMATION

Having made application for employment with Bethany Retirement Living, and desiring them to be informed as to my previous record and character, I hereby authorize Bethany Retirement Living and its authorized representatives to obtain information relating to my activities from educational institutions, licensing agencies and all persons or entities named on my employment application. This information may include, but is not limited to, academic, achievement, performance, attendance, personal history, discipline and conviction records. I hereby direct you to release such information upon the request of the bearer.

Further, I release any and all individuals and organizations, including record custodians, from and and all liability for damages of whatever kind or nature because of furnishing said information.

In connection with my application for employment with Bethany Retirement Living, I also understand that background checks will be performed on me if I receive an offer of employment from Bethany Retirement Living. I understand that an offer of employment is conditional on the results of the background information. The background information will be obtained through:

ADVANTAGE CREDIT BUREAU
5050 47th St S, Fargo, ND 58102
Toll free phone: 1-800-568-4478 / Fax: 701-239-9963

I understand the information obtained from a background check my include my past employment history, criminal history and driving record. I further understand that the background information is not limited to the current state of my residence, but may include information from any other state where I have resided.

I authorize all persons and companies contacted by the employer or its representatives to provide the requested background information. I understand and agree to release the aforesaid from any liability for collecting my background information.

I understand that if adverse action is taken by Bethany Retirement Living based on the results of my criminal background check, I will be given notice orally, in writing, or electronically of such adverse action. I further understand that I may request in writing within a reasonable period of time, a complete disclosure of the nature and scope of the background investigation. I also understand that I have the right to dispute the accuracy or completeness of any information furnished by the reporting agency. I further understand that the reporting agency supplying the information does not make the decision to take adverse action and cannot give specific reasons for the adverse action, only the employer makes such a decision.

I further authorize Bethany Retirement Living, if I am hired, to request a background report about me, for employment related purposes, at any time during the course of my employment to the extent allowed by law. I agree that this Disclosure and Release will be valid, now or in the future, in original, faxed, copied, or electronic form.

I also give my consent to Bethany Retirement Living and to Sanford Laboratory to perform the appropriate test(s) to identify the presence of drugs and/or alcohol. I furthermore give my permission for the test results to be released to Bethany Retirement Living. I understand that refusal to take this test, attempts to adulterate the sample, or a positive test may result in Bethany Retirement Living removing my application from consideration. In addition, I understand that Bethany Retirement Living does not allow smoking on its property.
Name *
First Middle Last

Social Security #

Format (xxx-xx-xxxx)

Any other name(s) used *

Have you lived anywhere else in the last 7 years

Yes

No

Previous Address
Street Address City State / Province / Region ZIP / Postal Code

Previous Cities/States of Residence during last 7 years

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Voluntary Information
As an affirmative action employer, we must monitor our equal employment opportunity and affirmative action program, and report the results to government agencies. Please help us gather this information by identifying your sex, race or ethnicity, and disability status on this form.
Providing this information is completely voluntary. If you choose not to provide some or all of this information, you will not be subject to any negative or adverse treatment.
The information you provide will be used only to monitor our compliance with equal opportunity laws and regulations and for no other purpose . When we have received this form, we will immediately place it in a confidential file separate from our application. If you wish, you may mail this form to us in an envelope separate from the one that contains your application.
This section is not used for employment decisions.

Bethany Retirement Living is an equal opportunity/affirmation action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protect veteran status, sexual orientation, gender identity, or any other characteristic protected by law.

Sex
---- Male Female

Race/Ethnicity

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Do you have a disability? *
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: blindness, deafness, cancer, diabetes, epilepsy, autism, cerebral palsy, HIV/AIDS, schizophrenia, muscular dystrophy, bipolar disorder, major depression, multiple sclerosis (MS), missing limbs or partially missing limbs, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), impairments requiring the use of a wheelchair, intellectual disability (previously called mental retardation). If you have a disability and need an accommodation so that you can perform the duties of the job for which you are applying, please notify us in some other manner. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternative format, using a sign language interpreter, or using specialized equipment.

--- Yes, I have/had a disability No, I don't have a disability I don't wish to answer

Protected Veteran Status

Disable Individual

Vietnam Era Veteran

Newly Separated Veteran

Disabled Veteran

Other Protected Veteran (Korean, Persian Gulf Operations, etc)

Name
First Last

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Voluntary Self-Identification of Disability

Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp .

How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your "major life activities." If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

• Blindness
• Autism
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Deafness • Cerebral palsy
• Major depression
• Obsessive compulsive disorder
• Cancer • HIV/AIDS
• Multiple sclerosis (MS)
• Impairments requiring the use of a wheelchair
• Diabetes
• Epilepsy
• Schizophrenia
• Muscular dystrophy
• Missing limbs or partially missing limbs
• Intellectual disability (previously called mental retardation)

Please Select One of the Following *

Yes, I have a disability, or have had one in the past

No, I do not have a disability and have not had one in the past

I do not want to answer

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