Potential Strike - multi-state
Submit Request
ER Tech - Emergency Room Tech
Requirements
:
BLS
2 years ER Tech / EMT experience
California EMT certification (preferred)
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have BLS certification?
*
No
Yes
Do you have a CPI or MAB certification?
*
No
Yes
Do you have a California EMT or Paramedic certification?
*
No
Yes
List any other certification you have:
*
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?
*
No
Yes
Can you work a Mid shift?
*
No
Yes
Can you work a Night shift?
*
No
Yes
What is your Primary Shift preference?
*
Day
Mid
Night
100% Flexible
How many years ED Tech experience do you have?
*
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 an ED Tech in the past year?
*
No
Yes
What Facility and City, state have you worked as an ED Tech most recently?
*
Have you worked in an ER?
*
No
Yes
Have you worked on an ambulance?
*
No
Yes
Can you start an IV?
*
No
Yes
Can you do a 12 lead EKG?
*
No
Yes
Can you draw blood using proper tube collection colors?
*
No
Yes
What is your level of comfort with children?
*
Not Comfortable
Somewhat Comfortable
Comfortable
Very Comfortable
What is your level of comfort with Infants?
*
Not Comfortable
Somewhat Comfortable
Comfortable
Very Comfortable
Please supply an Emergency Contact name and phone number:
*
