Submit Request

First Name*

Last Name*

Email*

Phone*

Do you have an Ophthalmology Tech (VSA) certification?*

No

Yes

Do you have a BLS certification?*

No

Yes

List any additional certifications you may hold:

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 experience do you have as an Ophthalmology Tech?*

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

No

Yes

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

How much experience do you have in a hospital setting?*

How much experience do you have in an outpatient setting?*

Have you worked in any other settings or modalities? *

No

Yes

If so, how long and what type of setting or modality?*

Can you collect patient ocular history, systemic illness, medications and drug allergies, etc?*

No

Yes

Do you have basic Tonometry experience? (indentation, applanation, intraocular pressure, etc)*

No

Yes

Do you maintain instruments and equipment including projectors, scopes, screens, lenses, lamps, etc?*

No

Yes

Can you assist during minor surgeries with ocular dressings and shields?*

No

Yes

Can you execute various vision tests and perform basic Lensometry?*

No

Yes

What equipment and brands do you have experience with?*

What experience do you have with imaging technology, if any? (HRT, OCT, etc)*

Please supply an Emergency Contact name and phone number:*

Ophthalmology Tech - ALLIED