Submit Request

First Name*

Last Name*

Email*

Phone*

Do you have 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 Ortho Tech?*

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

No

Yes

At what facility have you worked as an Ortho 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?*

Are you skilled with dressing changes and the proper application of aseptic techniques?*

No

Yes

Can you assemble traction equipment and attach supports, exercise frames, etc?*

No

Yes

Can you outfit patients with crutches, canes, and boots, with attention to staples, sutures, etc?*

No

Yes

Can you document interventions in the medical record?*

No

Yes

How confident are you to provide technical guidance pertaining to Ortho devices and equipment:*

What equipment and brands do you have experience with?*

Please supply an Emergency Contact name and phone number:*

Ortho Tech - ALLIED