PERSONAL INFORMATION
*DATE::
*LAST NAME:
*FIRST NAME:
*ADDRESS:
APT:
*CITY:
*ZIP:
*STATE:
*PHONE:
BEST TIME TO CALL:
PERSONAL INFORMATION CONTINUED...
*AGE:
SOCIAL SECURITY NO:
*DATE OF BIRTH:
ARE YOU A US CITIZEN:
NAME OF PARENT/GUARDIAN:
RELATIONSHIP:
EMPLOYMENT INFORMATION
POSITION:
FULL TIME OR PART TIME:
ARE YOU EMPLOYED:
NAME OF EMPLOYER:
WORK PHONE:
WORK ADDRESS:
EDUCATION
Below, give information concerning High School Graduated from or G.E.D. Certificate
Received:
DATE OF ENTRY:
CITY:
 NAME OF SCHOOL:
DATE G.E.D. RECEIVED:
STATE:
YEAR GRADUATED:
Give Information Concerning Colleges or Universities Attended:
CITY:
 STATE:
NAME OF SCHOOL:
DATE OF ENTRY:
DEGREE:
 CERTIFICATE:
SPECIAL INTEREST
IN THE SPACE PROVIDED BELOW, PLEASE INDICATE  YOUR
REASON(S) FOR SELECTING CERTIFIED NURSES ASSISTANT
AS A PROFESSION.
YOUR REASONS FOR SELECTING TLC TRAINING CENTER AND
YOUR PLANS FOR THE FUTURE.
WHICH PROGRAM ARE YOU INTERESTED IN.
EMERGENCY CONTACT
In case of emergency notify:
NAME
CITY, STATE, AND ZIP:
ADDRESS:
RELATIONSHIP:
PHONE
I certify that all the information in the above application is
correct to the best of my knowledge.
I authorize TLC Health Care Training Center to contact me
via phone, cell phone, fax, text, mail, or email, regardless
of being registered with the local, regional or national do
not call registry.
* Required.
The Health Industry is the largest employer in the USA! Health care provides 13.5 million jobs. Wage and
salary employment in the health care industry is projected to increase 27 percent through 2014, compared
to the 14 percent for all industries combined. Employment growth is expected to account for 3.6 million
new wage and salary jobs.

Take a moment to fill out the application below. You will be glad you did.
TLC HEALTHCARE INSTITUTE APPLICATION PAGE
TLC HealthCare Institute
4747 Lincoln Mall Drive,  Suite 407
Matteson, IL. 60443

CALL NOW!
708-679-1822/Fax 708-679-1826

www.tlchealthcareinstitute.org
tlchealthcaretraining@yahoo.com
Medical Terminology, EKG, and Phlebotomy Classes Coming Soon!
HEALTHCARE INSTITUTE
While Competency Training Programs may differ from state to state; the state of Illinois requires a
minimum of 80 theory hours and 40 hours of  clinical. Students are taught 21 Performance skills that
are required to demonstrate competency for successful completion of the course.  Please visit these
websites for further detailed information:

www.nurseaidetesting.com
http://www.idph.state.il.us/nar/home.htm