Potential Strike
Multi-State
submit request
Ultrasound Sonography - ALLIED
Requirements
:
BLS
ARDMS certification
-- please complete this form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active ARDMS?
*
No
Yes
What is your ARDMS registration number?
Do you have BLS certification?
*
No
Yes
Are you an RVT (Registered Vascular Technician)?
*
Yes
No
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 much recent experience do you have as an Ultrasound Tech?
*
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 Ultrasound Tech in the past year?
*
No
Yes
What Facility have you worked as an Ultrasound Tech most recently?
*
What age patients do you care for?
*
Can you perform cardiac echo?
*
No
Yes
Can you perform OB ultrasound?
*
No
Yes
What specialty or hospital unit are you the most comfortable in?
*
Describe your experience with vascular studies:
*
Please supply an Emergency Contact name and phone number:
*
