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First Name*

Last Name*

Email*

Phone*

In which region(s) would you prefer to be placed as an OR Tech?*

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?*

What ages are you comfortable caring for?*

Can you scrub CABG?*

No

Yes

Can you scrub Valves?*

No

Yes

Can you scrub Triple A?*

No

Yes

Which types of transplant cases can you scrub, if any?*

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

Do you have experience with Vascular?*

No

Yes

Do you have experience with Dental?*

No

Yes

Do you have experience with Eyes?*

No

Yes

How much experience do you have with total spine, if any?*

How much experience do you have in Urgent Surgery, if any?*

Which other areas or specialties can you scrub?*

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?

What robotics equipment or brands are you familiar with?*

Do you have experience with infusion pumps?*

No

Yes

Do you have experience with ultrasound machines?*

No

Yes

Do you have experience with smoke evacuators?*

No

Yes

Please supply an Emergency Contact name and phone number:*

Potential Strike - multi-state

Submit Request