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First Name*

Last Name*

Email*

Phone*

Do you have BLS certification? *

No

Yes

Are you a Certified Hemodialysis Technician?*

No

Yes

List any other certification you have:*

What specialties do you float to?*

Do you have the COVID Vaccination?*

No

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 a Hemodialysis Tech?*

Have you worked as a Hemodialysis Tech in the past year?*

No

Yes

At what facility have you worked as a Hemodialysis Tech most recently?*

How many years experience do you have with Inpatient dialysis?*

How many years experience do you have with outpatient dialysis?*

Which machines have you used?*

Can you access a Hemodialysis port?*

No

Yes

Can you access an AV graft?*

No

Yes

Can you clean the machines?*

No

Yes

Are you comfortable taking call for any and all dialysis emergencies?*

No

Yes

How many patients do you monitor at once on Dialysis?*

California - Potential Strike

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Dialysis Tech