Potential Strike - multistate

Submit Request

OR Tech OB

Requirements:

BLS
NBSTSA-CST

-- please complete this submission form honestly and accurately --

First Name*

Last Name*

Email*

Phone*

Do you have BLS certification? *

No

Yes

Do you have CST certification?*

No

Yes

If yes, what is your CST number?

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 OR Tech experience do you have?*

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

No

Yes

At what facility have you worked as an OR Tech most recently?*

Which types of specialties can you scrub?*

Have you worked inpatient?*

No

Yes

Have you worked outpatient?*

No

Yes

Can you scrub NICU and peds cases?*

No

Yes

Can you scrub L&D cases?*

No

Yes

Can you float to the main OR?*

No

Yes

With which types of procedures are you the most familiar?*

Can you work Sterile Processing?*

No

Yes

Can you First Assist?*

No

Yes

If yes, are you First Assist Certified?*

No

Yes

If you can first assist, which type of cases can you assist in?

Please supply an Emergency Contact name and phone number:*