Potential Strike - multi-state
Submit Request
CNA - Certified Nursing Assistant
Requirements
:
CNA license
BLS
CA-Home Health (required for Home Health CNA positions)
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
In what state(s) do you hold an active CNA license?
*
What is your active CNA license number?
*
In what region(s) would you prefer to be placed as a CNA?
*
California - Northern
California - Southern
Mid-Atlantic
Oregon
Washington
No Preference
Do you have BLS certification?
*
No
Yes
Do you hold an active California state Home Health certification?
*
No
Yes
List any additional certifications you may hold:
*
What specialties do you float to?
*
Do you have the COVID Vaccination?
*
No - Requesting Exemption
Yes - Vaccinated
Yes - Vaccinated with Booster
Typically for strike assignments: 5x12/hr shifts (60/hrs week) Are you ok with this?
*
No
Yes
Can you work a Day shift?
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No
Yes
Can you work a Mid shift?
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No
Yes
Can you work a Night shift?
*
No
Yes
What is your Primary Shift preference?
*
Day
Mid
Night
100% Flexible
How many years experience do you have as a CNA?
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None
6 Months or less
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
More than 10 Years
Have you worked as a CNA in the past year?
*
No
Yes
At what facility have you worked as a CNA most recently?
*
How much experience do you have in a hospital setting?
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None
6 Months or less
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
More than 10 Years
What type of clinic settings have you worked, if any?
Can you perform EKGs?
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No
Yes
Can you draw labs?
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No
Yes
Do you have 1:1 experience with mental health patients?
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No
Yes
What de-escalation training have you had, if any?
*
Do you have inpatient experience or outpatient experience, or both?
*
Inpatient
Outpatient
Both
List any other skills or duties you can perform:
*
Please supply an Emergency Contact name and phone number:
*
