Fall 2015 JVS/CCSF
Nursing Refresher Program Application
Background
JVS, in collaboration with City College of San Francisco’s Vocational Nursing Program, San Francisco
General Hospital and Laguna Honda Hospital, offers a 17-week, 4 day/week training program for
Licensed Vocational or Registered Nurses, trained either in the United States or abroad, who need a
refresher course or want a nursing skills brush-up to reenter the nursing field.
The program will include:

Over 450 total hours of theoretical, skills lab, & clinical practice experience at CCSF and 2 local
medical facilities;

General support in completing the course (individualized coaching & referral to resources);

Job search, interviewing, online application and networking skills instruction at CCSF;

Job search and placement assistance – we’ll help you get your first or next Nurse Job!
Application Process
Applicants must submit their complete application by May 15, 2015. JVS may offer more than one
Nurse Refresher program; applicants may apply to both but participate in only one of the courses. Due
to the high volume of anticipated applications, incomplete applications and applications submitted after
the deadline will not be considered for the program. Meeting all eligibility requirements does not
guarantee acceptance and preference is given to applicants who have been out of the field of nursing in
any setting for at least one year.
Program Eligibility Requirements

Must possess and submit proof of current, active California LVN or RN nursing license

If a native English speaker, a score placing applicant in English 92 on CCSF English placement
test, or provide a copy of U.S. nurse diploma or transcripts with application

If a non-native English speaker, a score placing applicant in ESL 150 on the CCSF ESL placement
test, or provide a copy of U.S. nurse diploma or transcripts with application

CCSF English language placement testing information is on the last page of this document

Proof of valid authorization to work in the U.S.

Active American Heart Association BLS for Healthcare Providers certification

Able to provide clear and current medical exams and immunization records

Able to pass a criminal background check and drug screen
Participant Commitments

Full participation in educational and job search components of the program (adherence to a very
strict attendance policy). Students must complete a job search portfolio.

Providing JVS staff with full employment details (job title, employer, wage, hours, benefits
offered) for any job obtained while enrolled in or after completion of the Nurse Refresher
program is required. This obligation is a condition of the Nurse Refresher program funders.

Regular communication with JVS staff for 1 year after placement in an LVN or RN job.
Cost
Most of the Nursing Refresher fees are covered by funding from foundations and private donors. The
cost of the program to the participant will be between $100 and $300 for stethoscope, physical
examination and immunizations*, background check/drug screen*, and other supplies/materials as
needed. You must calculate and cover your own transportation costs.
*You will need a physical examination and immunization record completed by a medical provider in
order to take this course. You will also need to pass a criminal background check/drug screen.
Health screen and background check information and forms will be provided to you later
in the application process by the JVS Program Coordinator if you are seriously considered
for acceptance to the program.
Class Schedule (Subject to change)
The Fall 2015 San Francisco Nursing Refresher course will run from August 24 – December 14, 2015.
The first 3 weeks are spent in the classroom and skills lab at CCSF, and beginning September 14, 2015,
students will be split in 2 groups; one group going to SFGH and the other going to LHH. In 7 weeks,
these 2 groups will switch, each group rotating to the other site.
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Monday
Tuesday
Wednesday
Thursday
8/24-9/11/15
3:00–8:30pm
3:00–8:30pm
3:00–8:30pm
3:00–8:30pm
Dates
Monday
Tuesday
Wednesday
Thursday
9/14-12/14/15
12:30-7:00pm
6:45am-
6:45am-
12:30–7:00pm
3:00pm/2:00–
3:00pm/2:00–
10:30 *
10:30*
Dates
Dates
9/21 –
Monday
12/14/15
10:00am12:00pm (job
search skills
practice: resume
writing, online
applications,
interviewing,
networking)
* indicates time in clinical assignment.
Clinical rotation at Laguna Honda Hospital is 6:45 am – 3:00 pm. Clinical rotation at San Francisco
General Hospital is 2:00 pm – 10:30 pm. Each rotation lasts 7 weeks.
Confidentiality Disclosure
This application and supplemental documentation will be shared with representatives from City College
for the purposes of application to the Nursing Refresher course only. City College strictly follows the
Federal Education Rights to Privacy Act (FERPA), which protects you as a student.
FALL 2015 APPLICATION FORM
Complete t his appl i cation in full and provide all r equired documentation . This is a
fillable document. Y ou can enter information on this form and save it to your own
computer to email or print. If you need this document in an alternate format
please contact the J VS Program Coordinator.
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Applicant Information
First Name:
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Last Name:
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Street Address: Click here to enter text.
City, State: Click here to enter text.
Zip Code: Click here to enter text.
Home Phone: Click here to enter text.
Cell phone: Click here to enter text.
Fax:
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Email Address: Click here to enter text.
Date of arrival in the U.S. (if applicable): Click here to enter text.
Primary languages spoken: Click here to enter text.
Are you currently or have you ever been a JVS client?
Choose an item.
If so, who was your main contact at JVS? Click here to enter text.
How did you hear about this course? Click here to enter text.
Have you ever been enrolled at CCSF? Choose an item.
Under what name were you enrolled as a student?
If Yes, when?
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Have you ever applied to a Nurse Refresher course before? Choose an item.
When?
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Where was the course?
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Have you ever participated in a Nurse Refresher or re-entry course before?
When?
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Where was the course?
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Part 1: Education, Training and Licensure
What was the name of your nursing school?
Where was it located?
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What year did you graduate?
How long was the program?
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Do you currently have an active California LVN or RN license?
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If yes, what is the type of license, license number and date of expiration?
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If expired, are you in the process of up-dating it? Choose an item.
When do you anticipate your license will be valid? Click here to enter text.
If inactive, are you in the process of reactivating it?
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When do you anticipate your license will be active again? Click here to enter text.
All applicants must provide license numbers and all licenses will be verified on the CA BVNPT or BRN
website. Is your license restricted/suspended/encumbered or otherwise under any disciplinary action?
Please select an answer: Choose an item.
If yes, please describe the circumstances of the disciplinary action:
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Have you ever participated in a nursing program beyond an ADN or BSN level program? If yes, please
describe:
Part 2: Nursing Work Experience
Describe in detail your professional nursing experience, if applicable. Include job titles, years employed,
locations, and areas of work (e.g. medical/surgical, pediatrics, SNF, clinic, etc.). What are your career
goals? Please attach a resume.
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If you are currently working, volunteer and/or paid, where are you working and what is your title?
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Part 3: Personal Statement
Why do you want to enter this program, what would you like to gain and what will you contribute to
other students in the program? What experiences have motivated and reinforced your desire to pursue
nursing? What personal characteristics and skills set you apart? What would you like the Nursing
Refresher program staff to know about you?
Part 4: Supplemental Intake Questionnaire
Section A – Work and School Load
1. How many hours per week are you currently working or attending school?
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2. Do you plan on changing or reducing your work or school hours if you are accepted into the Nursing
Refresher program?
Select one:
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3. Please explain how you plan to balance your work/school load with the full-time commitment of the
Nursing Refresher program:
4. Have you talked to your employer about applying for this program?
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5. How many hours per week do you plan to work while participating in the program?
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Section B – Family Responsibilities
1. Do you have children below the age of 18 or any adult dependents you must care for? Please select
one: Choose an item.
2. If yes, how many?
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3. Do you have help with the care of your children or adult dependent(s)?
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Section C – Transportation
1. How do you plan to get to class, and how long do you estimate it will take you?
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2. How do you plan to get to the clinical sites, and how long do you estimate it will take you?
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Section D – Applicant Questions
Please share any questions or concerns you have about the program here:
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Applicant Checklist
Required documents must be submitted to JVS coordinator – Due by May 15, 2015:
 Completed JVS application form
 Copy of CA LVN or RN nursing license
 Nurse resume
 CCSF English as a Second Language placement test results (150 or higher)* OR
 CCSF English placement test results (English 92 or higher)* OR
 A copy of U.S. Nursing diploma or U.S. nursing transcripts
* IMPORTANT: Notes about the CCSF English and ESL placement tests:
 Applicants who studied nursing in a language other than English must take the CCSF for credit
ESL placement test. Test results from other schools or the TOEFL will not be accepted. Nonnative English speakers who attended nursing school in the United States can also show
completion of a college level English course by providing a copy of their U.S. Nurse diploma or
transcripts.
 Applicants who speak English as their first language are required take the CCSF for credit English
placement test, or show completion of a college level English course by providing a copy of
their U.S. Nurse diploma or transcripts.
 For a schedule of test dates call 415-239-3128 / 415-239-3124, or check the CCSF Orientation &
Placement Testing website: http://www.ccsf.edu/NEW/ccsf/en/future-students/future-creditstudents/take_a_placementtest.html
-
Non-native English speakers: Under “Placement Testing Schedules” heading click on “ESL
(English as a Second Language)” for testing schedules.
-
Native English speakers: Under “Placement Testing Schedules” heading click on “Native
English testing” for testing schedules.
If you are eligible, have submitted all of the required documents, and are selected to move
forward with the application process, you will:
 Complete a phone screen with the JVS Nursing Refresher Program Coordinator
Upon serious consideration for acceptance into the program, you will be required to:
 Complete an in-person interview with the JVS Nursing Refresher Program Coordinator and
Provide the following:
 Physical examination and immunization record completed by a medical provider and complete
background check and drug screen results
-
Forms and instructions will be provided by the JVS Coordinator, do not request
 American Heart Association BLS for Healthcare Providers card valid through 12/18/2015
 Documents establishing your eligibility to work in the United States, such as:
-
Unexpired U.S. passport, Permanent Resident or Employment Authorization card
-
Valid Social Security card and Driver’s license or ID card
Please submit completed applications and all supporting documents via email, fax or U.S. mail to:
Nursing Refresher Program
Attention: Leah Olson
225 Bush St. Suite #400
San Francisco, CA 94104
Fax: (415) 391-3617
|
Email: lolson@jvs.org
APPLICATION DEADLINE: Friday, May 15th, 2015
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