LPN Application

Please provide the following information in the form:

Personal Information

United States +1
United States +1
DO YOU HAVE A VALID DRIVER’S LICENSE?
CDL?
HAVE YOU EVER SERVED IN THE MILITARY?
DO YOU HAVE THE LEGAL RIGHT TO OBTAIN EMPLOYMENT IN THE UNITED STATES?
CAN YOU PERFORM THE ESSENTIAL FUNCTIONS AND RESPONSIBILITIES OF THE POSITION FOR WHICH YOU ARE APPLYING?
DO YOU REQUIRE ANY SPECIAL ACCOMMODATION TO PERFORM REQUIRED DUTIES?
HAVE YOU EVER WORKED FOR INSPIRED GRACE HEALTHCARE, INC.?
DO ANY OF YOUR RELATIVES WORK FOR INSPIRED GRACE HEALTHCARE, INC.?

Mandatory: All Applicants with An Illinois License or Cna Certification Must Provide the License or Certification Number, Date of Such License or Certification.

 

CPR OR FIRST AID CERTIFICATION

HAVE YOU EVER BEEN CONVICTED OF ANY CRIMINAL OR DRIVING OFFENSE(S) OTHER THAN A MINOR TRAFFIC VIOLATION?

You Must Provide at Least Three Current Reference Letters And/or the Name of Individuals with Whom a Reference Interview Can Be Conducted. Please Give the Full Name, Mailing Address, and Phone Number of Three References Who Have Knowledge of Your Background and Qualifications in The Field.

Education and Skills

LEVEL OF EDUCATION COMPLETED

Experience

List Last 5 Years of Work Experience

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USD
MAY WE CONTACT?
United States +1
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MAY WE CONTACT?
United States +1
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MAY WE CONTACT?
United States +1
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USD
MAY WE CONTACT?
United States +1
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MAY WE CONTACT?
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 I agree to carry out the designated responsibilities to the best of my ability. I have read the position description. I am aware there is a conditional period of 3 months prior to permanent employment.

I certify that I have given true, accurate and complete information on this form to the best of my knowledge. I authorized investigation of statements made in this application and understand that false information may be grounds for denial of my position and/or dismissal if I am employed.

04/02/2025

Please click to view and download the forms:

LPN Skills Checklist

1 = Clinicals Only

2 = Some Experience

3 = Experienced

4 = Can Perform Task Independently

Neurological System

NEURO ASSESSMENT/NEURO VITALS *
HALO TRACTION *
SEIZURE PRECAUTIONS *
SPINAL CORD INJURY *
HEAD INJURY *
PRE / POST NEUROLOGICAL SURGERY *
REHABILITATION OF THE NEURO PATIENT *
CNS INFECTIONS *
PARKINSONS *
AUTONOMIC DYSREFLEXIA *
ALZHEIMERS *
CHRONIC C.V.A / T.I.A *
USING GLASCOW COMA SCALE *

Cardiovascular

CAPILLARY REFILL *
EDEMA *
HEART TONES *
PULSES *
ANGINA (ACUTE AND CHRONIC) *
ASSESSING AND TREATING ORTHOSTATIC BP *
ASSESSING ABNORMAL HEART TONES *
ANTIEMBOLIC DEVICES *

Patients with Respiratory Problems

Assessing the Respiratory System including:

BREATH SOUNDS *
BREATHING PATTERN / EFFORT *
COUGH EFFORT *
SKIN AND NAIL BED COLOR *
SPUTUM (COLOR/CHARACTER) *
Care and Maintenance of:
ACUTE AIRWAY *
NASOPHARYNGEAL AIRWAY *
OROPHARYNGEAL AIRWAY *
Administering and Monitoring O2 including:
NASAL CANNULA *
MASK *
O2 SATS *
DEMONSTRATING PROPER USE OF AMBU BAG *
Care of Ventilator Dependent Patient:
SUCTIONING: LENGTH OF TIME SUCTIONING *
HYPERVENTILATION *
VENTILATOR SETTINGS *
DOCUMENTATION *
Caring for a Patient with:
RESPIRATORY FAILURE *
RESPIRATORY INFECTIONS *
STATUS ASTHMATICUS *
RESPIRATORY DISTRESS SYNDROME *
PULMONARY EDEMA *
PULMONARY EMBOLI *
TENSION PNEUMOTHORAX *
TRACHEOSTOMY *
USE OF INCENTIVE SPIROMETER *

Gastrointestinal

ASSESSING BOWEL SOUNDS *
IDENTIFYING ABNORMALITIES *
CARING FOR PATIENT ON TOTAL PARENTERAL NUTRITION *
INSERTING /MAINTAINING FEEDING TUBES (NG) *
ADMINISTERING TUBE FEEDINGS *
ABDOMINAL WOUNDS OR INFECTIONS *
ILEOSTOMY/COLOSTOMY *
STOOL TESTS *
I&O: SHIFT VOLUMES AND TOTALS INCLUDING MARKING AND/ *
OR MEASURING AMOUNTS OF URINE, GASTRIC FLUID *
NG DRAINAGE, EMESIS, DIARRHEA *

Genitourinary / Renal

INSERTING/MAINTAINING URINARY DRAINAGE TUBES: *
INSERTION OF FOLEY *
MANAGING UROSTOMY *
MANAGING SUPRAPUBIC CATHETER *
PLACING CONDOM CATHETER *
CARING FOR PATIENTS WITH CHRONIC RENAL FAILURE *
CARING FOR PATIENT RECEIVING DIALYSIS *
ASSESSING FLUID AND ELECTROLYTE PROBLEMS *
KNOWLEDGE OF UA VALUES *
COLLECTING SPECIMENS *

Endocrine

Caring for the Diabetic Patient:
CHECKING CAPILLARY BLOOD GLUCOSE *
DIABETIC TEACHING *
TREATING HYPO/HYPERGLYCEMIA *
INSULIN ADMINISTRATION *
HORMONE THERAPY *

Muscuskeletal

TRACTION *
BRACES *
CASTS *
COLLARS *
SLINGS/SPLINTS *
SKELETAL AND SKIN TRACTION *
Beds:
CLINITRON *
ROTO REST *
CRUTCH WALKING/WALKERS *
CIRCELECTRIC *
ARTHROSCOPY/ARTHROTOMY *
Caring for Patients with:
JOINT/BONE DISORDERS *
TOTAL KNEE REPLACEMENT *
TOTAL HIP REPLACEMENT *
AMPUTATION *

Vital Signs and Weights

Obtaining and Recording:
BP, INCLUDING ORTHOSTATIC *
PULSE, RADIAL *
TEMPERATURE, ORAL *
TEMPERATURE, RECTAL *
RECOGNIZING CARDIAC ARREST *
CARDIOVERSION DEFIBILATION *
ACTIVATING CODE TERM *
BRINGING EMERGENCY EQUIPMENT TO ROOM *
DNR STATUS *
TEMPERATURE, AXILLARY *
TEMPERATURE, TYMPANIC *
RESPIRATIONS *
WEIGHT, POUNDS AND KILOGRAMS *
Use of Electronic VS equipment:
APPLYING OXIMETER *
ELECTRONIC THERMOMETER *
AUTOMATIC BP MACHINE (DYNAMAP) *
Scale Use:
STANDING *
CHAIR *
BED *
RECODING AND REPORTING INFORMATION *

Hygiene / Skin

RISK FACTORS FOR SKIN BREAKDOWN *
OBSERVING, RECORDING AND REPORTING PRESSURE POINTS FOR REDNESS OF BREAKDOWN *
RECORDING AND REPORTING HYGIENE/SKIN//BREAKDOWN *
Bathing/Daily Hygiene:
BATHING (SHOWER/TUB/ARJO) *
USE OF SHOWER CHAIR *
USE OF BATH/SHOWER BOAT *
ORAL CARE INCLUDING PATIENTS WHO ARE NPO, COMATOSE, WITH DENTURES *
PERI CARE *
FOOT CARE FOR PATIENTS WITH IMPAIRED CIRCULATION OF SENSATION *
INCONTINENCE CARE *
SHAVING AND PRECAUTIONS *
Use of Pressure and Friction Reduction Devices:
SPECIAL BEDS/MATTRESSES *
HEELS AND ELBOW PROTECTION *
FOOT CRADLES *

Nutrition

ESTIMATING INTAKE *
SETTING UP FOR MEALS *
ASPIRATION PRECAUTIONS *
NOURISHMENTS *
FEEDING PATIENTS *
COUNTING CALORIES *
FLUID RESTRICTION *
NPO *
RECORDING AND REPORTING NUTRITIONAL INFORMATION *

Care Routine

New Admissions and Transfers:
ROOM PREPARATION *
VS. HEIGHT AND WEIGHT *
INVENTORY AND DISPOSITION OF BELONGINGS *
ROOM ORIENTATION, CALL BELL *
BASIC COMFORT MEASURES *
PREPARING FOR AND EXPLAINING ROUTINES TO PATIENT *
POST MORTEM CARE *

Safety and Activity

DETERMINING PATIENT ID *
IDENTIFYING/RESPONDING TO SAFETY HAZARDS *
DETERMINING NEED FOR ADDITIONAL HELP *
Recognizing Abuse:
SUBSTANCE *
PHYSICAL *
EMOTIONAL *
MAINTAINING CLEAN , ORDERLY WORK AREA *
HANDLING HAZARDOUS MATERIALS *
PROPER BODY MECHANICS *
ROM EXERCISES *
TRANSFER TO BED, WC, COMMODE WITH OR WITHOUT DEVICE *
TURNING AND POSITIONING *
REPORTING BROKEN EQUIPMENT *
AMBULATING WITH OR WITHOUT DEVICE *
PATIENT SAFETY MODULE *
USE OF HOYER LIFT (DEXTRA/MAXI) *
BED OPERATION *
USE OF WHEEL LOCKS *
USE OF ALARMS (BED, PATIENT, UNIT) *
USE OF ALARMS (BED, PATIENT, UNIT) *
USE OF CALL LIGHT *
APPLICATION AND DOCUMENTATION OF RESTRAINTS: BELT, INCLUDING SEAT BELT WRIST/ANKLE VEST USE OF SEIZURE PADS *

Infection Control

Medication and Administration

Proper Use of Specific Barrier Methods:
GLOVES *
GOWN *
MASK/GOGGLES *
PROTECTIVE/REVERSE ISOLATION *
BRODY SUBSTANCE ISOLATION *
TB PRECAUTIONS *
MRSA PRECAUTIONS *
HAND WASHING *
INFECTIOUS/HAZARDOUS WASTE DISPOSAL *
SUPPLY/EQUIPMENT DISPOSAL *
USE OF DISPOSABLE THERMOMETER *
USE OF CPR MASK/BAG *
DISPOSAL OF SHARPE *

Line Skills

VENIPUNCTURE FOR SPECIMEN *
ADMINISTERING BLOOD AND BLOOD PRODUCTS *
IV Therapy Including:
STARTING IV *
CHANGING IV SITES *
CHANGING IV DRESSINGS *
CHANGING IV TUBING *
ADMINISTERING FLUIDS ON CONTINUOUS IV PUMPS *
SETTING UP AND MONITORING PCA *
OBTAINING CENTRAL VENOUS/PERIPHERAL VENOUS BLOOD *
USING PICC, HICKMAN, TRIPLE LUMEN CATHS *
SET UP AND MONITORING FOR TPN *
CIMETIDINE (TAGAMET) *
DIAZEPAM (VALIUM) *
DIAZEPAM (VALIUM) *
DURAMORPH *
FUROSEMIDE (LASIX) *
HEPARIN *
INSULIN *
TERBUTALINE *
THEOPHYLLINE *
VERAPAMIL (CALAN) *
ORAL MEDICATIONS *
LORAZEPAM (ATIVAN) *
MORPHINE *
NALOXONE (NARCAN) *
NITROGLYCERINE *
PENTOBARBITAL *
PHENYTOIN (DILANTIN) *
POTASSIUM CHLORIDE *
TOPICAL MEDICATIONS *
Suppositories:
VAGINAL *
RECTAL *
ORDERING MEDS *

Other Skills

PROVIDING EDUCATION TO PATIENT FAMILY RELATED TO MEDICAL CONDITION, SELF CARE AND HEALTH CARE HABITS *
USING COMPUTERIZED TOOLS EFFECTIVELY *

Communication

USING APPROPRIATE ABBREVIATIONS *
IDENTIFYING NEED FOR ALTERNATE COMMUNICATING MECHANISMS *
Communicating to Charge RN:
CHANGES IN PATIENT CONDITION *
PATIENT NEEDS, COMPLAINTS AND CONCERNS *
UNUSUAL INCIDENTS *
REINFORCING RN TEACHING WITH PATIENT *
SELECTING AND USING FORMS APPROPRIATELY *
USING ALTERNATE COMMUNICATION TOOLS/DEVICES *

Unit Activity

IDENTIFYING UNUSUAL INCIDENTS ON THE UNIT THAT REQUIRE REPORTING *
LOCATING AND USING APPROPRIATE REFERENCE MATERIALS *
COMPLETING RISK MANAGEMENT REPORTS AS NEEDED *
CHARGING FOR PATIENT CARE ITEMS *
OBTAINING NEEDED SUPPLIES AND EQUIPMENT *
USING TELEPHONE SYSTEM *

Miscellaneous

Knowledge of Serum Lab Values Including:
CHEM 7, CHEM 10 *
CBC *
SERUM DRUG LEVELS *
PAIN MANAGEMENT *
CARING FOR DRAINS/TUBES (I.E. HEMOVAC, PENROSE) *
MONITORING AND ASSESSING I & O *
PERFORMING COMPLEX DRESSING CHANGES *
ALERT CHARTING *

Additional Documents

Use this section to attach the following: TB test, Covid Card, Social Security Card, CPR, Nursing License, & Physical

Attach up-to 6 documents. Maximum of 9MB. Note that if you’re having trouble uploading one of the enabled filetypes, that filetype may be restricted by our security.

    Confirmation

    04/02/2025