After completing the application, you will be redirected to documents that you must sign electronically.

Applicant Information
CNA Basic Reading and Math Test
Body Parts Test
Criminal Background Check
Release of Liability and Assumption of Risk
Authorization to Release Educational Information
Redirection Notice

Company

CNA Student Application

Location

South Bend / Mishawaka

Indianapolis / Carmel / Noblesville

Fort Wayne

Class Time - (Hidden)

Class Time

Days – 3 weeks long – 1st week M-F 8:00 – 4:30pm; 2nd/3rd week clinicals 6:30am – 3:00pm

Evenings – 6 weeks – M-Thurs 5:00-10:00pm

Weekends – 6 weeks - Sat/Sun – 7:00am – 5:30pm

Contact Information

Full Name *

Email Address *

Re-enter Email Address *

Street Address *

City/State/ZIP *

Contact Number *

Alternative Contact Number

Education

Highest Education Completed *

Payment Type

Private Pay Sponsored

Criminal History

The Criminal History and CNA Registry Check for all potential states were verbally explained to student.

Student Initials *

CNA Student Application

CNA Training Program - Basic Reading Test

DIRECTIONS: Read the following paragraphs and carefully answer the questions that follow it by CLICKING on the one best answer, either a, b, or c.

The fastest growing segment of the population in the United States is the elderly. The number of long-term health care facilities must increase to meet their needs. Because of medical advances, more people are living to adulthood and old age. Because of the growing number of long-term health care facilities, we are concerned that the elderly receive quality care.

Nursing assistants provide most of the personal care to the elderly residents. A nursing assistant helps in feeding, bathing, and dressing residents, as well as many other daily tasks. The nursing assistant can be the resident's best friend.

1) What is the fastest growing segment of our population? *

A. preschoolers

B. teenagers

C. the elderly

2) It is our concern that the elderly receive: *

A. quality care

B. discount rates

C. medical attention

3) Most of the direct care to the elderly in long-term facilities is carried out by: *

A. Registered Nurses

B. Medical doctors

C. Nursing assistants

When you take a person's temperature, you are measuring body heat. The body produces heat by breaking down food and by exercise. The body loses heat by perspiration and breathing. When the body is working properly, its temperature will fall within the normal range. The normal oral adult temperature range is between 97.6 and 99.6 degrees Fahrenheit as measured by a thermometer.

1) Which is NOT on of the ways your body produces heat? *

A. exercise

B. breathing

C. breaking down food

2) The normal oral adult temperature range is between: *

A. 97.6 - 99.6 F

B. 96.7 - 98.6 F

C. 98.6 - 99 F

3) You use a thermometer to measure: *

A. Blood pressure

B. Temperature

C. Perspiration

When a new resident is admitted to a long-term facility, they often feel a great deal of stress. Their families can also feel stress. You can help lessen their stress by being helpful and kind.

There are many ways to be helpful. You should call a resident by their correct name like "Mrs. Smith" and not "sweetie", "honey", or other similar names. Talk slowly and clearly, not rushed. Take time to answer their questions carefully. Encourage them to participate in activities so they can meet people and made to feel at home.

1) Many times, people feel __________ when being admitted to a long-term care facility *

A. fear

B. stress

C. happiness

2) A good way to be helpful is to: *

A. talk slowly and clearly

B. answer questions carefully

C. both A & B

3) Participating in activities helps new residents: *

A. meet people

B. work up an appetite

C. sleep better at night

CNA Training Program - Math Test

Directions: Read each question then circle the correct answer. you may use this paper to figure on.

1. Mary earns $300.00 each month. How much money will she earn in one year? *

A. $36,000.00

B. $1,800.00

C. $3,600.00

2. Which number is the smallest: *

A. 7101

B. 7010

C. 7106

D. 7061

3. Which number is the largest? *

A. 60,196

B. 601.96

C. 61,069

D. 609.61

Below are a series of addition and subtraction problems. Place the correct answer under each case.

ADDITION:

1110 + 995 = *

7 + 11 + 9 = *

150 + 255 = *

50 + 66 + 78 = *

SUBTRACTION:

120 - 80 = *

250 - 180 = *

90 - 42 = *

200 - 13 = *

MULTIPLICATION:

15 x 3 = *

82 x 10 = *

147 x 9 = *

200 x 12 = *

DIVISION:

12 ÷ 4 = *

147 ÷ 7 = *

250 ÷ 2 = *

CNA Student Application

CNA Training Program - Body Parts Test

This is a body part test that should be filled out by looking at each number/arrow that is pointing at a particular body part. Please fill in the blank which corresponds with each body part number. An example would be that # 1 is pointing at the ear so you would write in ear for #1. No medical terminology is needed, just the names of the basic body parts.

Body Parts Test

1) *

2) *

3) *

4) *

5) *

6) *

7) *

8) *

9) *

10) *

11) *

12) *

13) *

14) *

15) *

16) *

17) *

18) *

19) *

20) *

CNA Student Application

RELEASE TO OBTAIN LIMITED CRIMINAL HISTORY REPORT

Pursuant to Indiana State Code Section 18, IC 16-28-13 and Section 19 requiring that a criminal history report be obtained on any person working in a health facility, I give permission to Legacy CNA Training, LLC., to obtain my limited criminal history report from the Indiana Central Repository for Criminal History Information under IC 5-2-5 or another source allowed by law.

Sex *

Race

AKA

DOB *

Please list all states where you have lived in the past 5 years: *

Have you ever been arrested for or convicted of a crime that has not been expunged by a Court? *

Yes No

Date *

CNA Student Application

Release of Liability and Assumption of Risk

I am enrolled as a student in course(s) offered by Legacy CNA Training, LLC. I understand that my training involves physical activities which have a risk of physical harm to me.

In consideration of the education and training which I am receiving and will receive in the future from Legacy CNA Training, LLC, the receipt of sufficiency of which is hereby acknowledged, I hereby release and forever discharge Legacy CNA Training, LLC, their employees, officers, directors, agents, and assigns, from any and all claims, demands, actions, causes of action, injuries or suits of any kind or nature whatsoever resulting from my participation in the course of study provided by Legacy CNA Training, LLC. I assume all risk of injury to myself while participating in this course of study.

I declare that I am aware of the physical demand of the course of study. I represent that I have no physical limitations that would render me unable to perform the physical activities of the course of study.

I declare that I am not an employee of Legacy CNA Training, LLC, but rather receive educational and training services from Legacy CNA Training, LLC, in order to prepare me for employment by other parties.

I declare that the terms of this instrument have been completely read, fully understood, and voluntarily accepted.

IN WITNESS WHEREOF, I have hereunder set my hand this 20th day of April, 2025.

Initials *

By entering your initials, you confirm that you have read and agree to the terms above.

CNA Student Application

Authorization to Release Educational Information

I hereby authorize Legacy CNA Training, LLC, to release information from my training records to potential employers.

Have you gone by any other last name? *

Yes No

Have you previously been licensed as a CNA? *

Yes No

Once you hit submit, you will be redirected to these documents to be signed electronically:

Release to Obtain Limited Criminal History Report
Release of Liability and Assumption of Risk
Authorization to Release Educational Information
Referred Student Agreement
Resident Rights & Abuse Prevention
Photo Waiver
Elder Justice Act
CNA Student Registration

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CNA Registration

CNA Student Application

Location

Class Time - (Hidden)

Contact Information

Education

Payment Type

Criminal History