Submit Request

First Name*

Last Name*

Email*

Phone*

Do you have a CST certification?*

No

Yes

If yes, what is your CST number?

Do you have BLS 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 Endo Tech experience do you have?*

Have you worked as an Endo Tech in the past year?*

No

Yes

What Facility, city and state have you worked as an Endo Tech most recently?*

Do you assist with ECRPs?*

No

Yes

Do you assist with bronchs?*

No

Yes

What other cases do you assist with?*

Can you scrub in the main OR?*

No

Yes

If yes, which OR cases?

Do you clean and process scopes?*

No

Yes

Can you assist with E.R.C.P.s?*

No

Yes

Can you label tissue specimens for Pathology?*

No

Yes

Can you handle hot and cold biopsies?*

No

Yes

How much experience do you have with Endoscopic ultrasound?*

How much experience do you have with Esophageal dilation and Sclerotherapy?*

How much experience do you have with Peg placement?*

How much experience do you have with Variceal banding?*

Can you start an IV?*

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

Which brands of equipment are you familiar with?*

Please supply an Emergency Contact name and phone number:*

Endo Tech - ALLIED