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First Name*

Last Name*

Email*

Phone*

Do you have BLS certification? *

No

Yes

Do you have ARRT / Mammography certification?*

No

Yes

If yes, what is your ARRT certification number?

Do you have a California Mammography 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 Mammography Tech experience do you have?*

Have you worked as a Mammography Tech in the past year?*

No

Yes

What Facility have you worked as a Mammography Tech most recently?*

Are you comfortable with diagnostic positioning for breast implants vs non-breast implants?*

No

Yes

Do you understand assistance needs of patients with various medical conditions?

No

Yes

Are you familiar with 3D Holistic equipment?*

No

Yes

Are you familiar with Affirm equipment?*

No

Yes

What other equipment, if any, are you familiar with?*

Do you do assist with Biopsies?*

No

Yes

Do you give contrast for studies?*

No

Yes

Please supply an Emergency Contact name and phone number:*

Mammography Tech - ALLIED