New Partner Form
Welcome to Infinite Health Care Academy! We are excited to help connect you to our top CNA students to help help fulfill your staffing needs. Please complete this brief form which will allow us to better assist you. We appreciate your feedback as we strive to produce skilled, certified nursing assistants that will meet the needs of your company and the healthcare industry. Thank you.
Your Name
*
First Name
Last Name
Your Title/Role
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Company Name
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Website
*
Company Size
*
Please Select
0-1 Employees
2-10 Employees
11-50 Employees
51-100 Employees
101-250 Employees
251-500 Employees
501-1000 Employees
1000+ Employees
Facility Type
*
Please Select
Adult Day Care
Assisted Living
Home Care
Hospice
Hospital
Nursing Home
Long Term Care
Other
Referred By
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Please Select
Current/Former Student
IHCA Staff
Email
Facebook
Google
LinkedIn
Twitter
Other
Does your company work with a 3rd party hiring company?
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Yes
No
If your company does work with 3rd party hiring companies, please list them.
*
Please list at least three (3) schools your company partners with or is interested in partnering with.
*
Please list the name then location. Example format: Infinite Health Care Academy - Midway, GA
Back
Next
Submit
Hiring Needs/Goals
Average candidates seeking to hire each month...
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0 to 5
6 to 10
11 to 15
15+
Which positions would you be looking to hire?
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Home Health Aide (HHA)
Patient Care Technician (PCT)
Certified Nursing Assistant (CNA)
Phlebotomy Technician (PHL Tech)
Certified Medication Aide (CMA)
EKG Technician (EKG Tech)
I affirm and certify that all the information and answers to the above questions are complete, true and correct to the best of my knowledge.
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Clear
Date
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-
Month
-
Day
Year
Date
Submit
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