Potential Strike - California
Submit Request
Occupational Therapy - Allied
Requirements
:
California Occupational Therapy license
BLS
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active California state Occupational Therapy license?
*
No
Yes
List your Occupational Therapy license number:
RN license expiration date:
*
Do you have BLS 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
Do you have Charge RN experience within the last two years?
*
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 Occupational Therapy 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 Occupational Therapy in the past year?
*
No
Yes
At which Facility have you worked Occupational Therapy most recently?
*
What clinic settings do you have experience working in?
*
Describe your experience with Occupational Therapy:
*
What age patients are you comfortable caring for?
*
Do you have NICU experience?
*
No
Yes
Do you have experience with Medicare / MedicAid?
*
No
Yes
Are you able to complete relevant insurance documentations?
*
No
Yes
Do you have experience with private insurance?
*
No
Yes
Are you proficient in discharge planning for Occupational Therapy?
*
No
Yes
Can you lift 50-100lbs?
No
Yes
Do you have NICU experience?
*
No
Yes
Do you have behavioral health experience?
*
No
Yes
Do you have experience with admitted patient?
*
No
Yes
Are you comfortable to provide training and education for patients and their loved ones?
*
No
Yes
What charting software/brands do you have experience with?
*
Please highlight any additional clinical skills or unique experience you may have:
Please supply an emergency contact name and phone number:
*
