The Springfield-Holyoke Workforce Development Initiative for Healthcare, led by Baystate Health, is focused on training unemployed and incumbent individuals as patient care technicians through a collaborative effort among hospitals, career centers, and community organizations. The initiative aims to recruit a diverse group from underserved communities, enhancing their skills to meet healthcare workforce needs while fostering job placement opportunities and understanding among stakeholders. This comprehensive program includes recruitment strategies, training sessions, and ongoing support, ultimately promoting economic self-sufficiency for participants in the healthcare sector.

1. Overview
News and Events
What is a Sector Strategy
Promising Practices
Tools and Technical Assistance
Research and Resources
Current
Baystate Health
Past
Community Work Services
Community Voice Mail
Boxes
Fresh from the Field
Utilizing One Stop Career Centers and Community-
Based Organizations to Recruit, Assess & Select
Training Participants
The Springfield-Holyoke Workforce Development Initiative for
Healthcare, lead by Baystate Health, is in its final year of a Round
Two Workforce Competitiveness Trust Fund project, training both
unemployed and incumbent participants for jobs as patient care
technicians. The project is supported by a partnership of 2
hospitals, 2 career centers, 3 training providers and several
community based organizations. One of the goals of this project is
to recruit a diverse group of unemployed individuals from
underserved communities to address the need for these additional
skilled acute-care workers.
During their planning grant, Baystate Health and Mercy, the two
employer partners, realized that they could not solely rely on their
traditional recruitment strategies in order to achieve this goal.
Working with their local One Stop Career Centers (OSCC) and
community-based organization(CBO) partners, they developed a
comprehensive recruitment strategy that would draw from a
diverse, untapped population.
While the partnership developed this strategy to find individuals to
participate in this program, they also wanted to create an
infrastructure that would educate and prepare job seekers for
careers in health care and create an ongoing pool of job seekers to
meet the hospitals’ workforce needs.
Working together, the partners designed outreach activities and
tools, identified assessment tools and selection criteria, and
created an integrated selection process that utilized the expertise
and relationships of all of the project partners. Using this process,
both CBOs and OSCCs were actively recruiting participants. CBOs
made referrals to the OSCCs, who would then assess and screen
applicants based on initial screening criteria developed by the
Partnership. OSCCs maintained weekly communication with the
Grant Project Coordinator at Baystate Health, as well as with each
referring CBO. Keeping the referral source updated on the
applicant’s progress throughout the process allowed project staff to
offer support where needed.
In addition to this strategy resulting in qualified grant participants,
it has also led to closer working relationships between the
employers, OSCCs and CBOs. OSCC and CBO partners report
having a better understanding of health care careers and education
requirements to share with their customers. The employer partners
report a better understanding of the benefits of working with local
workforce development partners in meeting their workforce needs.
See the Springfield-Holyoke Workforce Development Initiative for
Healthcare WCTF Acute Care CNA Grant Guide to Outreach &
Recruitment.
For more information on this project contact Amy Rist at
amy.rist@bhs.org or 413-794-6093
Page 1 of 1baystate health

2. Guide for One-Stop Career Centers
Grant Referral & Application Process
This guide compiles necessary information to guide you through the external recruitment and
outreach process related to the grant.
Amy Rist, Project Coordinator, WCTF Grant
Baystate Health
June 2009

3. Guide for One-Stop Career Centers Page 1
Table of Contents
VISION STATEMENT 2
GENERAL OVERVIEW OF RECRUITMENT & OUTREACH 3
TARGET AUDIENCE 3
PRINCIPLES FOR RECRUITMENT & OUTREACH 4
EXAMPLES OF SPECIFIC OUTREACH EFFORTS 5
TOOLS FOR COMMUNITY OUTREACH 6
INFORMATIONAL SESSIONS 6
OTHER MATERIALS 6
REFERRAL & APPLICATION PROCESS 7
GENERAL PROCESS OVERVIEW 7
KEY DATES 8
TRACKING APPLICATIONS 9
COMMUNICATING WITH REFERRAL SOURCE 9
REFERENCE CHECKING 10
THE APPLICANT FILE 11
TOOLS & TEMPLATES 12

4. Guide for One-Stop Career Centers Page 2
Vision Statement
Springfield-Holyoke Workforce Development Initiative for Healthcare
We envision . . . .
. . . . a collaborative alliance between healthcare industry employers, community
organizations and educational organizations that provides Pioneer Valley’’s diverse
residents gainful employment in healthcare with abundant opportunities for both
current and newly skilled workers to achieve economic self-sufficiency. This
strong bond between the healthcare employers, community based organizations,
employers and educational organizations strengthens the region’’s vibrant and
diverse healthcare workforce and employers fostering a future in which quality
and authentic care is delivered to us all.
We will achieve this vision by:
Increasing the pool of knowledgeable, qualified, motivated, diverse and
clinically competent job seekers to meet the hospitals’’ workforce needs
now and in the future.
Formalizing the region’’s career ladders and lattices available to healthcare
workers.
Providing career guidance to healthcare job seekers and current workers
to assist them in making educated decisions with their occupational goals.
Preparing job seekers to successfully gain meaningful employment in entry-
level positions within the healthcare industry.
Providing additional skills and training opportunities for current healthcare
workers in order to help them to overcome their barriers and advance
them within the industry via their career ladder/lattice.
Building the cultural competence of all stakeholders in order to create the
conditions for success.

5. Guide for One-Stop Career Centers Page 3
General Overview of Recruitment & Outreach
TARGET AUDIENCE
This high-level description describes the individuals we hope to recruit in an effort to best
align with the vision of the grant. It also aligns with the requirements of both the training
organization and employers to ensure their progression throughout the program.
Could not access this training without this grant program
Springfield or Holyoke resident
18 years of age or older
High School Diploma or GED
Can read and write English
CORI clear of issues in the immediate past
At least one former employer (supervisor) reference with one additional
reference required (employer, teacher, clergy, etc.)
Has a clear understanding and interest in a career in healthcare and the
work of a Certified Nursing Assistant (Patient Care Technician)
Can attend all required classes throughout the 2 –– 3 month training
program, if selected
Must be able to accept a position provided to them, should they become
available, with one of our employer partners*
*Though no guarantee of job placement is made, the employers are committed to providing
preference and placement for applicants completing this program should positions become
available.

6. Guide for One-Stop Career Centers Page 4
PRINCIPLES FOR RECRUITMENT & OUTREACH
These principles should be embedded in every aspect of the recruitment and outreach
process in an effort to enable equitable access to application for all eligible applicants.
Ensure individuals clearly understand and demonstrate an interest in a
career in healthcare, with a basic understanding of the occupation for which
they will be trained if selected.
Ensure the individual has a demonstrated motivation and commitment
through the referrals or references provided.
Do not restrict application on the basis of existing barriers to training or
employment, but understand and prepare the applicant with the resources
and tools they need to succeed.
Enable all applicants to access the services of the one-stop career center to
ensure that, if not selected for the grant program, they can continue to
review other programs or services they may qualify for.
Remind participants that limited spots are available under this grant,
however their involvement in this process will enable them to access many
other services and programs should they not be selected.

7. Guide for One-Stop Career Centers Page 5
EXAMPLES OF SPECIFIC OUTREACH EFFORTS
These examples serve to provide a blueprint for those programs to target when
identifying applicants for the grant.
Community-Based Organizations or Educational Institutions with
existing programs for which their staff have relationships with individuals in our
community, and thus can identify individuals who may benefit from this program.
These programs include, but are not limited to:
GED program graduates with some employment experience
Advanced ESL graduates with a GED or High School diploma
Pre-health, transitional college prep, or other post-high school preparatory
education students preparing for the next step
Parenting programs requiring a parent to obtain training and education
leading to potential employment
One-Stop Career Center Customers that have met with a career counselor
and reflect a demonstrated interest in healthcare or have attended an
informational session at which they have demonstrated an understanding of the
grant program and profession for which they will be trained.
Important Notes:
Individuals currently unemployed should be highly considered and
encouraged, at the first opportunity, to apply for approval of ““Section 30””
training if selected. The training programs that are approved under Section
30 for this program are listed as the following in TrainingPro:
o MCDI, Inc. Course #1001251 Nurse Aide
o Holyoke Community College Course #1075812 Workforce
Partnership Nursing Assistant Program

8. Guide for One-Stop Career Centers Page 6
Tools for Community Outreach
INFORMATIONAL SESSIONS
For staff of community organizations or individuals considering applying to the grant. A
patient care technician will be on site to describe the work they do and answer questions.
FutureWorks, Springfield MA
June 24, 2009 from 1 –– 2:00 PM
Register with Delia Maldonado at 858-2843
CareerPoint, Holyoke MA
June 30, 2009 from 1 –– 2:00 PM
Register with Darlene Orciuch at 532-4900
An additional session will be offered at each site near the end of July; we will
update you once that is scheduled.
OTHER MATERIALS
The following list of documents have been provided in this kit and can be customized in
some cases for specific purposes.
Flyer Announcing Program (customizable)
Flyer Announcing Information Session (customizable)
Potential Applicant Information Form
General Overview of the Grant for Community Applicants
General Description of a Patient Care Technician
Community Application & Referral Form
WCTF Grant Project Profile
Coming Soon PowerPoint handout from Information Session
Coming Soon Agenda for Information Session
To request printed, color copies of any of these documents for your needs,
please contact Amy Rist, Project Coordinator at 794-6093.

9. Guide for One-Stop Career Centers Page 7
Referral & Application Process
GENERAL PROCESS OVERVIEW
The following provides a general overview of the referral and application process.
Phase Key Tasks Key Partners Involved
Referral &
Application
Informational Sessions provided at one-stop career
centers
Targeted outreach performed at area community
organizations
Referral staff meet with individual and review program
and requirements
Applications completed and forwarded to the applicable
one-stop career center lead contact
Community
Organizations and their
staff, teachers, etc.
One-Stop Career Center
staff including career
counselors
Testing &
References
Applicant information documented on tracking sheet*
Meeting scheduled and held with applicant to review
application, obtain references and schedule TABE testing
One-Stop intake process completed and applicant
entered into MOSES
References contacted and documented
Testing completed and scored
Scores of testing reviewed with applicant
All required documentation (identification, verification
of education, etc.) obtained and placed in file
Consistent contact with referral source throughout
process to provide status
Applicant file prepared and scheduled for pickup by
Project Coordinator
One-Stop Career
Centers
File Review Review applicant file and obtain missing documents if
needed
Prepare copies and distribute to employers for review
Clarify any questions on information received
Project Coordinator
Employers
Interviews Upon approval of applicant file, contact applicant to
schedule an interview at the one-stop
Hold interviews
o 30 minutes BMC employer
o 30 minutes MMC employer
Send interview guides to project coordinator with
recommendations
Schedules final interviews per employer recommendation
Hold Project Coordinator interviews
One-Stop Career Center
Employers
Employers
Project Coordinator
Project Coordinator
Observation Possible observation of a Patient Care Technician to be
scheduled by Project Coordinator for final round
applicants only (depending on hospital accessibility)
Project Coordinator

10. Guide for One-Stop Career Centers Page 8
Phase Key Tasks Key Partners Involved
Applicant
Selection
Final applicants selected Pending CORI and scheduled
for training provider intake
Community Organizations contacted with all applicant
results
Applicants not selected contacted and meeting
scheduled to review other options
Project Coordinator
Project Coordinator
One-Stop Career Center
Training
Provider
Intake
Applicant registers for training and authorizes CORI
review
Applicant provides or presents plan to provide physical
and immunization documentation to provider per their
guidelines
CORI results received and notification given to Project
Coordinator of ““clear”” or ““not clear””
Applicant contacted with final determination
Training Provider
KEY DATES
The dates below are in place to guide the process; adjustments may be necessary due to
factors outside of our control.
FINAL DAY FOR APPLICATIONS RECEIVED AT ONE-STOP
July 31, 2009
ALL APPLICANT MATERIALS SENT TO PROJECT COORDINATOR
July 31, 2009
PROJECT COORDINATOR & EMPLOYERS REVIEW APPLICATIONS
August 3 –– 7, 2009
EMPLOYER & PC INTERVIEWS AT ONE-STOP
August 10 –– 21, 2009
ACCEPTANCE PENDING CORI
August 24, 2009
TRAINING PROVIDER IN-TAKE, CORI AUTHORIZATION
August 25 –– September 4, 2009
CLASS BEGINS AT STCC
September 22, 2009
CLASS BEGINS AT HCC
October 26, 2009
CLASS BEGINS AT MCDI
October 19, 2009

11. Guide for One-Stop Career Centers Page 9
TRACKING APPLICATIONS
Our grant outcomes require that we track all actual applications received, regardless of
whether they were selected or not.
Objectives of the Applicant Tracking Sheet
Ensure our outreach plan is producing an acceptable number of qualified
applicants
Understand the reasons why some applicants do not continue through the
process
Effectively meet our state grant outcomes requiring identification of actual
applications received
Instructions for use:
1. Use the Applicant Tracking Sheet provided with this document to track all
application received at your organization.
2. Forward the latest copy to the Project Coordinator at the end of each
week:
Via email: amy.rist@bhs.org (preferred) Via fax: 794-7954
COMMUNICATING WITH REFERRAL SOURCE
This process is setup so that applicants come from an existing referral source –– someone
that has a relationship with the individual who can provide coaching and support through
the application process. Keeping them updated on the applicant’’s progress throughout
the process will allow them to offer support where needed.
At major milestones throughout the recruitment process, the one-stop career
center should keep the referral source updated either via phone or email on their
client’’s success. Information such as test results, acceptance/denied acceptance
from the grant should first be given directly to the applicant, and then to the
referral source so they can provide support if needed.

12. Guide for One-Stop Career Centers Page 10
REFERENCE CHECKING
Our goal is to provide an opportunity for job placement at one of the employer partners
of this grant. Obtaining references early on in the process better increases the
probability of that outcome.
Employers typically require at least one former supervisor (employer) reference
upon application for a position, and another reference from someone with
knowledge of the individual’’s dependability, transferable skills, etc.
At the first meeting with the applicant, have the individual fill out the top section
of each reference form. Should they want to provide additional references, they
can, but are not required to. Always encourage two employer references, though
they can apply with only one.
Reference forms are provided at the end of this document.

13. Guide for One-Stop Career Centers Page 11
THE APPLICANT FILE
The information included below are critical pieces of information required on every
formal applicant prior to transfer of the files to the Project Coordinator.
Originals of the following:
Grant Application & Referral Form
Resume (if provided)
Training Pre-Selection Form
Completed Reference Forms with notes from one-stop caller
Copies of the following:
Verification of Identity/Citizenship
High School Diploma or GED
Other Diplomas/Transcripts etc.
TABE Test Results
SDS Test Results
WorkKeys Test Results (if available)
One-Stop Worksheet for Public Programs
Letters of Reference or additional documentation provided by the applicant
If currently or pending receipt of unemployment benefits, status of Section
30 individual application for training
A blank checklist is provided at the end of this document and can be copied and
used for files.
Please contact Amy Rist to schedule pickup, as needed, of complete applicant files
ready for interview scheduling:
Phone: 413-794-6093 or 413-563-1090
Email: amy.rist@bhs.org
ALL FILES ARE DUE TO THE PROJECT OFFICE BY JULY 31, 2009

14. Guide for One-Stop Career Centers Page 12
Tools & Templates

15. Guide for One-Stop Career Centers Page 13
APPLICANT FILE CHECKLIST
Applicant Name
Place a checkmark next to each document type. * indicates required
*Grant Application & Referral Form
Resume (if not provided, enter N/A)
*Training Pre-Selection Form
*Supervisor/Employer Reference Form(s)
*Personal/Other Reference Form(s)
ORIGINAL
DOCUMENTS
Other (please describe)
*Verification of Identity/Citizenship (at least 2 forms of ID)
*High School Diploma or GED
Other Diplomas/Certificates/Transcripts (if none, enter N/A)
*TABE Test Results
SDS Test Results
WorkKeys Test Results (if none, enter N/A)
*One-Stop Worksheet for Public Programs
COPIED
DOCUMENTS
Other (please describe)
UNEMPLOYMENT STATUS
Is the applicant currently receiving unemployment
benefits?
YES NO
If yes, has the applicant applied for Section 30
Training Approval?
YES NO
Please add any applicable notes here:

16. Guide for One-Stop Career Centers Page 14
Potential Applicant Information Form
Today’’s Date
Full Name
Phone #
Email (if avail)
Community Organization
______________________________________
One-Stop Career Center
______________________________________
Educational Institution or Program
______________________________________
How did you hear about
the program?
Please provide the name of the
organization in the space
provided, where applicable
Other
______________________________________
Do you plan to apply for this program? YES NO
Thank you for your interest.

17. Begin your career in a
high-growth, high-demand
industry.
Find out about free training to become a
Patient Care Technician (Acute Care CNA)
and be prepared for jobs in our local hospitals.
In two—three months you can earn a CNA
certificate, CPR certificate, and receive brand
new training in critical acute care nursing aide
skills.
Information Sessions are coming up
soon...call now to find out more!
This initiative is funded through a Workforce Competitiveness Trust Fund grant from the Executive Office of Labor
and Workforce Development, administered through Commonwealth Corporation

18. Begin your career in a
high-growth, high-demand
industry.
Find out about free training to become a
Patient Care Technician (Acute Care CNA)
and be prepared for jobs in our local hospitals.
In two—three months you can earn a CNA
certificate, CPR certificate, and receive brand
new training in critical acute care nursing aide
skills.
Come to an Information Session
to find out more!
This initiative is funded through a Workforce Competitiveness Trust Fund grant from the Executive Office of Labor
and Workforce Development, administered through Commonwealth Corporation

19. Acute Care CNA Pilot Program
OVERVIEW FOR
COMMUNITY APPLICANTS
What is the Springfield – Holyoke Workforce Development
Initiative for Healthcare and the Acute Care CNA Pilot Program?
This initiative, funded through a Workforce Competitiveness Trust Fund grant
from the Executive Office of Labor and Workforce Development, administered
through Commonwealth Corporation, is a collaborative alliance between
healthcare industry employers, community organizations and educational
institutions that provide Pioneer Valley’s diverse residents gainful employment
in healthcare with abundant opportunities for both current and newly skilled
workers to achieve economic self-sufficiency. To accomplish this, a new
“Acute Care CNA" Pilot Training Program has been developed which
incorporates Certified Nursing Assistant (CNA) training, Soft Skills Training,
Acute Care SIM LAB Training, Career Coaching & Case Management. After
completion of the training, participants will gain a CNA credential and, even
more importantly, be qualified to work as a Patient Care Technician in an
acute care hospital environment.
What do accepted grant participants receive?
If accepted into this grant program, participants will receive:
8 - 14 weeks of CNA training including CPR at either Holyoke Community
College, Massachusetts Career Development Institute or Springfield
Technical Community College.
60 hours of Acute Care CNA training including both classroom, skill
demonstration, hospital clinical experiences and patient simulation
Minimal funding of support services while in training, depending on need
Assistance applying for placement into a Patient Care Technician position at
the two partner employers upon successful completion of training (starting
wage could be between $12 – 13.00 an hour)
To be eligibly to apply for this grant program, you must meet
the following criteria:
Must be a resident of Springfield or Holyoke, Massachusetts and a citizen of
the United States and be able to provide verification
Must have a High School Diploma or GED and be able to provide original
documentation to verify graduation
Must have at least two references that can be verified, with at least one
from a former supervisor/employer (two employer references preferred).
Second reference can be a former teacher, priest, community leader, etc.
Must not be in the process of, or have previously obtained, a Certified
Nurse Assistant training and/or certification
Must be able to read and write English
Must have a clean CORI (Criminal Offender Record Information) and SORI
(Sexual Offender Registry Information)
Must pass the minimum entrance testing (either TABE, WorkKeys, etc.)
Must have a physical with a healthcare provider within the last year as well
as immunizations such as TB (records will be required by training
providers)
Springfield-Holyoke Workforce
Development Initiative for
Healthcare
Career Center Partners
Employer Partners
Education Partners
Massachusetts Career
Development Institute

20. Acute Care CNA Pilot Program
General Job Description for a
Patient Care Technician
GENERAL RESPONSIBILITIES
The Patient Care Technician performs a variety of technical tasks and
bedside functions. Responsibilities include direct patient care; hygiene,
skin care, mobility and monitoring. The PCT is expected to manage
equipment and perform or assist in all procedures on unit. This role is a
member of a designated care team functioning under the direction and
supervision of a Registered Nurse.
CHARACTERISTICS OF A PATIENT CARE TECHNICIAN
Performs and assists patients with activities of daily living. In doing
so, performs bathing, positioning, skin care, ambulating, toileting
and assists with transportation.
Performs and records in patients’ charts, basic nursing care
procedures such as collecting routine specimens, taking vital signs,
intake and outpatient and weight.
Assist with achieving nutritional needs by preparing patient for
meals, deliver/remove trays, distribute water and feed patients.
Performs procedures and treatments such as EKGs, preps,
application and monitoring of patient’s response to restraints.
Performs and reports any findings on the following duties: straight/
Foley Catheters, hang tube feedings, enemas, point of care testing
and empty colostomy bags.
Assists in transferring patients, beds and patient care equipment to
other rooms adhering to necessary safety precautions.
Completes various errands as requested such as retrieving and
delivering supplies, specimens, instruments, test results, etc.
EXAMPLES OF MINIMUM REQUIREMENTS
High School Diploma or GED; CNA Certification; CPR Certification
EXAMPLES OF PHYSICAL REQUIREMENTS AND ABILITIES:
Requires exposure to blood and various body fluids, which require
caution and use of established safety guidelines and equipment.
Ability to lift and move heavy objects/patients with or without
reasonable accommodations.
EXAMPLE OF A TYPICAL SCHEDULE FOR A PCT
Three (3) 12-hour shifts per week totaling 36 hours per week (full-
time). Examples of Shifts include 7 am—7 pm; 7 pm—7 am; some
weekends are typically required for most positions.
Information provided is a general overview of the patient care technician job description at
acute care facilities and will vary across institutions.; no guarantee of job placement
Springfield-Holyoke Workforce
Development Initiative for
Healthcare
Career Center Partners
Employer Partners
Education Partners
Massachusetts Career
Development Institute

21. This initiative is funded through a Workforce Competitiveness Trust Fund grant from the Executive Office of Labor and Workforce Development,
administered through Commonwealth Corporation
Referral Information:
Community Organization Referring You:___________________________________________
Organization Contact Name:__________________________Phone #: ( _____ )_______-_________
Date of this Application: _____/_____/_________
Participant Information:
Last Name: ______________________________ First Name:_______________________________
Home Phone #: ( _____ )_______-____________Other (Cell/Mobile): ( _____ )______-_________
Address: __________________________________________________Apt #:_________________
City: ____________________ State: ______ Zip: _______
E-Mail (if applicable):_____________________________________________________________
Have you ever worked for Baystate Medical Center or Mercy Medical Center or one of their affiliated
institutions? Yes ___ No___
If yes, what were your dates of employment? __________________________________________
Under what name did you work at the time?____________________________________________
Primary Language: -English -Spanish -Russian -Vietnamese -Other:____________
Please list any other languages you are fluent in: ________________________________________
Have you taken the TABE (Test of Adult Basic Education) and/or WorkKeys in the past?
Yes ____No ____ If yes, where:__________________________Approx. Date____/____/_____
Education/Training
Highest or most recent school grade completed:
High school diploma _____ GED _____ Some college _____ Associates degree _____
College (Bachelor’s degree) _____ Masters _____ Doctorate _____Other advanced Degree _____
Have you received any special training, degree, license, or certification? Yes _____ No _____
If yes, List school and Major:___________________________________________________
Date Enrolled __________________ Date graduated__________________
Are you currently enrolled in high school, GED, college, or a training program? Yes ____ No _____
If yes, List school and Major:___________________________________________________
Date Enrolled__________________ Expected Graduation Date __________________
Springfield-Holyoke Workforce Initiative for Health Care
Community Application & Referral Form

22. This initiative is funded through a Workforce Competitiveness Trust Fund grant from the Executive Office of Labor and Workforce Development,
administered through Commonwealth Corporation
Current/Previous Employment Information: (resume can be attached but is not required)
Are you currently employed? Yes __ No __ If yes, please check one: Part time: __ Full time: __
Current or most recent employer: __________________________________________________
City: _____________________________________ State: _______________
Job Title: ___________________________________ Salary: ______________
Start Date: _____________________ End Date: ________________________
Days typically scheduled: _____________________ Shift Start/End: ________________________
Total Hours Worked Per Week: _________________
Reason for Leaving:_______________________________________________________________
Additional Employer Reference (if applicable): ____________________________________________
City: _____________________________________ State: _______________
Job Title: ___________________________________ Salary: ______________
Start Date: _____________________ End Date: ________________________
Days typically scheduled: _____________________ Shift Start/End: ________________________
Total Hours Worked Per Week: _________________
Reason for Leaving:_______________________________________________________________
(resume can be attached but is not required)
Applicant Acknowledgement of Requirements:
Please place a check mark next to each area to confirm you understand and can satisfy the following
requirements:
Clean CORI & SORI criminal background checks
Can Read/Write English
Citizenship can be verified
Ability to physically perform the role of Patient Care Technician (CNA) (see job description)
I have, or can obtain, a physical within the last year as well as immunizations including TB
Original documentation of education (HS, GED, etc.)
Two references (at least one from former/current supervisor or employer)
Not in the process of, or have previously obtained, training to become a CAN
If selected, can be available for attendance at all required class dates
Springfield-Holyoke Workforce Initiative for Health Care
Community Application & Referral Form

23. This initiative is funded through a Workforce Competitiveness Trust Fund grant from the Executive Office of Labor and Workforce Development,
administered through Commonwealth Corporation
Application Essays: (please complete and attach additional pages if necessary)
1. Please explain in your own words why you would like to participate in this program and why you
would like to become a Patient Care Technician.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
2. Please indicate your career goals for the next five (5) years.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
3. Please include any additional information that may be helpful to the Grant Selection Committee.
You can include extracurricular activities, volunteer activities, special honors or awards etc.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Springfield-Holyoke Workforce Initiative for Health Care
Community Application & Referral Form

24. This initiative is funded through a Workforce Competitiveness Trust Fund grant from the Executive Office of Labor and Workforce Development,
administered through Commonwealth Corporation
Applicant Certification: Please initial next to each section and sign at end.
_________I certify that the information provided in this application and any entry made by me is true to
the best of my knowledge and understanding. I understand that making false, misleading or incorrect
statements will result in my no longer being considered for this grant opportunity.
_________I further acknowledge that this document is not an application for employment and in no way
guarantees employment at any grant partner organization.
_________In the course of providing the best possible service to the participants in this grant program,
the exchange of information between employers, agencies and educational institutions may be
necessary. I hereby authorize the release of information, on a need to know basis, which is reasonably
necessary to accomplish the goals and objectives of this program. I understand that the information is
confidential and will only be shared with the agencies, institutions or parties listed below unless the
release or provision of such information is otherwise prohibited by law or regulation. I understand the
individuals that receive and use this information will hold it in the strictest confidence and will use it to
better serve me. I understand copies of this signed release will serve as valid authorization and the
original signed document will be kept in my file with the Project Coordinator of this grant.
Baystate Health, Inc. and all subsidiaries FutureWorks, Inc
Sisters of Providence Health System and all subsidiaries CareerPoint
Springfield Technical Community College Regional Employment Board of Hampden County, Inc.
Holyoke Community College Partners for a Healthier Community
Massachusetts Career Development Institute, Inc. New North Citizen’s Council
Urban League of Springfield
My signature below indicates my acknowledgement of all initialed sections above.
SIGNATURE: ________________________________________ DATE:____________________
Springfield-Holyoke Workforce Initiative for Health Care
Community Application & Referral Form
FOR WCTF GRANT INTERNAL USE ONLY Application Received (Date)_______________
Scheduled Interview
Dates/Times:
(depending on pro-
gress)
CAREER CENTER 1:
List Employer Preference if provided:
TESTING (TABE/SDS/WORKKEYS):
List TABE Scores Here:
CAREER CENTER FOLLOW-UP:
EMPLOYER HR:
PROJECT COORDINATOR:
TRAINING INTAKE AT
OBSERVATION ON EMPLOYER UNIT

25. Springfield-Holyoke Workforce Development Initiative for Health Care
Community Training Pre-Selection Form
CNA Training Program Pre-Selection Form for
Please write full Applicant Name above
Please review the program descriptions and date and time commitments. Please then check the box next to the training program you feel may work best
for you if selected as a participant of this grant. You will have an opportunity to adjust this selection if necessary should you be selected.
Training Provider Program Description Dates/Times
Holyoke
Community
College
303 Homestead Avenue
Holyoke, MA 01040
HCC has offered CNA training since 1995, and has graduated hundreds of CNAs who have gone
on to work for many Pioneer Valley healthcare organizations. Many graduates have since
entered nursing programs (LPN and RN) and are now licensed or registered nurses. Also
included in the instruction are non-technical workshops related to participants’ success in the
classroom and in their careers, as well as an introduction to computers workshop. The CNA
Program Specialist is available for all students in the CNA program to provide advising and
case management services, in cooperation with Baystate Health Systems and Mercy Hospital
project staff.
HCC’s CNA training program is a 210-hour program that consists of classroom instruction and
hands-on lab instruction held in the HCC Kittredge Center for Business & Workforce
Development at the HCC main campus in Holyoke, and four days of clinical instruction at an
area long-term care facility. Students will also receive First Aid/CPR training as well as the
National Alzheimer’s Certificate.
October 26 – December 11, 2009
Monday through Friday
Course Times:
Classroom, 9:00 am - 3:30 pm
Clinical days, 8:00 am - 3:30 pm
Massachusetts
Career
Development
Institute
140 Wilbraham Avenue
Springfield, MA 01109
This program is a state approved program that trains men and women interested in becoming
a Certified Nursing Assistant. The program includes classroom and lab instruction for a total of
240 hours. Extensive hands-on clinical experience is obtained while working directly with
patients under the guidance and supervision of a qualified instructor within local hospitals and
nursing homes. Students are prepared to take and successfully pass the state examination
leading to certification. They are also prepared for CPR certification for infants, children and
adults.
MCDI will also provide employment related seminars: Action for Career Employment,
workplace health and safety issues, problem solving, team building, quality assurance,
continuous quality improvement, and personal development.
Oct 19 – Dec 11, 2009
Monday through Friday
Course Times:
Classroom, 8:00 am - 2:30 pm
Clinical days, 8:00 am - 2:30 pm
Springfield
Technical
Community
College
1 Armory Square
Springfield, MA 01105
Part-time
Evening program
This training program will provide you with entry-level job skills that will allow you to enter the
health care field and prepare for the state board examination to become a Certified Nurse Aide
(CNA) and receive your certification in CPR. This course is taught by RNs with almost 30 years
of combined experience in teaching and nursing.
Major topics include communication skills, personal care basics, infection control, vital signs,
record keeping, safety & emergency procedures, CPR and certification exam review.
Sept 22 – Dec 17, 2009
Lecture and Lab: Tuesdays, some Wednesdays,
and Thursdays classes 5:00-9:00PM
September 22, 24, 29, October 1, 6, 7, 8, 13, 14,
15, 20, 22, 27, 28, 29, November 3, 5, and 10,
Site Visit: Thursday, November 12 (4:30-6:30 pm)
Clinical: Monday, Tuesday, Wednesday and
Thursday November 16, 17, 18, and 19 and Monday
and Tuesday, November 23 and 24, 4:30-8:30 pm
Exam Review Sessions: Tuesday and Thursday.
December 1 and 3, from 5:00-9:00 pm
CNA Exam: Week of December 7/Specific date TBA
CPR: Tuesday and Thursday, December 15 and 17,
from 5:00-9:00 pm
IMPORTANT NOTE: If you are currently on un-employment and would need to continue receiving unemployment while in training if selected
for this program, we encourage you to apply NOW for Section 30 individual approval for training. Please speak with your one-stop career
center counselor for more information.

26. Community Applicants
Springfield-Holyoke Workforce Development Initiative for Health Care
Supervisor/Employer Reference Form for
Date: _______________ One-Stop Staff:
Organization:_____________________________________
Candidate Name: ______________________________________________________________
Maiden Name: ______________________________________________________________
APPLICANT – FILL OUT THIS SECTION ONLY
Supervisor’s Name / Title
Company Name:
Phone#:
Address:
Position Held By You:
Dates of employment:
Reason for Leaving:
FOR STAFF USE ONLY
Did his/her work performance meet your expectations? If not, why?
__________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
What do you consider to be a strength? ____________________________________________________________
__________________________________________________________________
____________________________________________________________________________________________
Is this individual eligible for rehire with your company?
Are there any additional comments you would like to make about this candidate?
__________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

27. OTHER NOTES
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

28. Springfield-Holyoke Workforce Development Initiative for Health Care
Personal Reference Form for Community Applicants
Date: _______________ One-Stop Staff:
Organization:_____________________________________
Candidate Name: ______________________________________________________________
APPLICANT – FILL OUT THIS SECTION ONLY
Reference Name/Title
Address:
Phone#:
Relationship
FOR STAFF USE ONLY
How Long Have You Known This Person?
What do you consider to be a strength? ____________________________________________________________
__________________________________________________________________
____________________________________________________________________________________________
Are there any additional comments you would like to make about this candidate?
__________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
NOTES
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

29. Springfield-Holyoke Workforce Development Initiative for Healthcare
Project Profile
Lead Organization Baystate Medical Center (BMC), Springfield, Massachusetts
Funding Source Workforce Competitiveness Trust Fund (WCTF) Grant, through Massachusetts Executive
Office of Labor & Workforce Development
Administrator Commonwealth Corporation Grant Period July 1, 2008 – June 30, 2010
Total Funding $475,000 Total Match $145,075
Sector Healthcare Targeted Job(s) Patient Care Technician
Project Staff
Project Director Jean Jackson, VP Workforce Planning, Baystate Health
(413) 794-7943 jean.jackson@bhs.org
Project Coordinator Amy Rist (413) 794-6093 amy.rist@bhs.org
Project Clerk/Data Entry Giselle De Leon (413) 794-7977 giselle.deleon@bhs.org
Commonwealth Corporation Contact Theresa Rowland, Program Specialist
trowland@commcorp.org
Lead Organization Fiscal Contact Louise Morse, Director of Sponsored Programs, BMC
louise.morse@bhs.org
Project Partners
Workforce Board Regional Employment Board of Hampden County, Inc.
Employers Baystate Medical Center
Mercy Medical Center
Educational Institutions Holyoke Community College
Massachusetts Career Development Institute
Springfield Technical Community College
One-Stop Career Centers CareerPoint (Holyoke)
FutureWorks (Springfield)
Community-Based Organizations New North Citizen’s Council
Partners for a Healthier Community
Urban League of Springfield
Project Overview
This grant is designed to address the need for additional skilled acute-care workers and the shortage of long-term career
opportunities for people from underserved communities. The grant will finance the recruitment and training of 45 acute-
care certified nursing assistants (CNAs) and the training of seven current employees of Baystate Medical Center and
three employees of Mercy Medical Center. In recognition of the barrier to advancement for people who cannot afford to
give up their current jobs to pursue the education needed for a different career path, both hospitals will continue to pay
the salaries of employees in the program while they attend training. The grant also includes allowances for support
services such as child care and transportation.
This grant also includes a $50,000 allotment to the Regional Employment Board of Hampden County to support the
creation of a new regional workforce development partnership for healthcare. This partnership would bring together
healthcare industry employers, educational institutions, workforce development, regional philanthropy and community-
based organizations to address the common workforce needs of the industry. It would accomplish this through the
development of healthcare provider-education partnerships, innovative education, training and community outreach
programs, a comprehensive analysis of available funding currently used or that could be leveraged in the future, and the
implementation of policy strategy to advocate for more support of healthcare workforce development programs.

30. Springfield-Holyoke Workforce Development Initiative for Healthcare
Project Profile Summary Document
Page 2 of 3
Project Goals
Increase the number of entry-level, skilled clinicians through the development of health career pathways that target
lower skilled, incumbent workers and low-income residents from our community
Increase the diversity of the local healthcare workforce
Improve access to healthcare career pathways in the acute care setting through the development of new curriculum
Develop a sectoral approach in the creation of new partnerships between hospital employers, training providers,
workforce development entities and community-based organizations
Project Deliverables
Acute Care CNA Pilot Number Served
Project Staff hired and trained 2
Acute Care/SIM Lab Curriculum Developed 55
Soft Skills Curriculum Developed 45
Recruit & Train Incumbent Employees 10
Backfill Incumbent Positions 10
Recruit & Train External (pre-employment) participants 45
Regional Partnership Development
Stakeholders identified and invited to participate
Roles, responsibilities and governance structure defined
Shared goals/outcomes defined
Workforce data and “best practice” data collected and available in a centralized location
Plan developed to establish a centralized regional/state healthcare workforce information source
Healthcare workforce development funding priorities set
Training Outcomes
Outcome Measure
Pre-Employment
(external)
Incumbent
Workers
Total Number Participants Recruited Approx. 150 - 300 20
Total Number Participants Enrolled 50 10
Total Number of participants completing training 45 10
Number of participants gaining skill credential 45 10
Total Number of participants with wage gain as a result of training 45 10
Average wage increase anticipated 35% 5% – 15%
Number of job placements/new hires 45 10
Average wage at hire $12.00 - $13.00 $12.00-$16.00
Total number of participants with promotion as a result of training NA 10
Total number of participants retaining employment as a result of training NA 10

31. Springfield-Holyoke Workforce Development Initiative for Healthcare
Project Profile Summary Document
Page 3 of 3
Project Timeline
Grant Year 1 Grant Year 2
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8Major Activities
7/1 –
9/30/08
10/1 –
12/31/08
1/1 –
3/31/09
4/1 –
6/30/09
7/1 –
9/30/09
10/1 –
12/31/09
1/1 –
3/31/10
4/1 –
6/30/10
Acute Care CNA Pilot Project
Develop process to recruit incumbents X
Develop Acute Care/SIM Curriculum X X X
Develop Soft Skills Curriculum X X X
Train 10 Incumbent Employees X
Backfill entry-level internal jobs X X
Develop external recruitment & outreach
process
X X
Implement external recruitment & outreach
process
X X X X X X
Train 50 external participants X X X X X
Regional Partnership Development
Identify Sector Partners & Convene First
Meeting
X X
Define Governance Structure X X
Document supply & demand workforce data &
identify high priority needs
X X
Develop common goals & solutions and
document promising practices
X X X
Obtain signed MOA from partners X
Identify regional/state/federal funding priorities X X X X X X X X
Advocate for regional healthcare workforce
needs
X X X X X X X X