Potential Strike - multi-state
Submit Request
OR Orderly
Requirements
:
BLS (preferred)
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
In which region(s) would you prefer to be placed as an OR Orderly?
*
California
Mid-Atlantic
No Preference
Do you have BLS certification?
*
No
Yes
List any additional certifications you have:
*
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 experience do you have as an Orderly?
*
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 Orderly in the past year?
*
No
Yes
At what facility have you worked as an Orderly most recently?
*
How much experience do you have in the Operating Room?
*
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
Do you have experience assembling equipment?
*
No
Yes
Can you assist patients of all ages with ADLs?
*
No
Yes
Can you transport patients via gurney and wheelchair?
*
No
Yes
Do you have experience moving and positioning patients?
*
No
Yes
Can you lift 50-100lbs?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*
