Potential Strike
Multi-State
submit request
Respiratory Therapy - ALLIED
Requirements
:
BLS
CRT or RRT license
-- please complete this form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active California Respiratory Therapy practitioner license?
*
No
Yes
California RT license #?
*
California RT License Expiration Date:
*
Do you have NBRC - CRT certification?
*
No
Yes
Do you have NBRC - RRT certification?
*
No
Yes
Do you have BLS certification?
*
No
Yes
Do you have ACLS certification?
*
No
Yes
Do you have NRP certification?
*
No
Yes
Do you have PALS certification?
*
No
Yes
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 RT experience do you have?
*
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 RT specialty in the past year?
*
No
Yes
What Facility have you worked RT most recently?
*
What age patients do you care for?
*
Can you work in critical care ICU?
*
No
Yes
Have you worked in areas such as CVICU and managed rapid weaning processes on open heart patients?
*
No
Yes
Can you work in Pediatrics?
*
No
Yes
Can you work in pediatric or neonatal intensive care (PICU/NICU)?
*
No
Yes
Can you transport all ages in an ambulance?
*
No
Yes
Can you transport all ages in an helicopter?
*
No
Yes
Can you perform PFTs?
*
No
Yes
Can you intubate?
*
No
Yes
Can you extubate?
*
No
Yes
Do you have exp with Servo U?
*
No
Yes
Do you have exp with v60 bipap?
*
No
Yes
Do you have exp with Carefustion bipap?
*
No
Yes
Do you have exp with sensormatic 3100b?
*
No
Yes
Can you do arterial sticks?
*
No
Yes
Which brands of Vent are you experienced with?
*
Please supply an Emergency Contact name and phone number:
*
