School application
I am registering for*:Choose a Class
Name*
Address*
Provide 2 contact phones numbers, email and birth of date *:

Level of Education:(give name of school, year graduated) Understand you must supply Medical2 with a copy of HS diploma, GED certificate, or HS transcript upon beginning program of study.
Education*:

Work experience*:Beginning with present or last employer (name, address, dates employed, type of work)*
 
Do you have a working knowledge of computers?*:Have you ever been certified or licensed in a medical field before and what field?

Why do you want to take this program?*
 Medical 2 Career College and the State of Mississippi requires that students validate no history of the following charges according to Mississippi Code of 1972, Section 43-11-13.

 

 By signing below, I attest I have not been convicted of or pleaded guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult. I have not been convicted of or pleaded guilty or nolo contendere to other crimes which his/her employer has and/or would determine to be disqualifying for employment. By signing below, I give Medical 2 Career College permission to conduct a background check in accordance with the Mississippi State Law with the Department of Health Nurse Registry to provide a clean medical abuse record with the State of Mississippi and permission to conduct a background with the Mississippi Department of Public Safety.

 

 I am applying for admittance as a student at Medical 2 Career College in a healthcare program. Falsification of information on any application is reason for dismissal and loss of all payments made.