Potential Strike - California
Submit Request
Physical Therapy - Allied
Requirements
:
California Physical Therapy license
BLS
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active California state Physical Therapy license?
*
No
Yes
List your California Physical 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
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 Physical 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 Physical Therapy in the past year?
*
No
Yes
At which Facility have you worked Physical Therapy most recently?
*
What facility settings do you have experience working in (hospital, clinic, nursing home, etc)?
*
Describe your experience with Physical Medicine:
*
In what areas do you specialize?
*
What age patients are you comfortable caring for?
*
Do you have NICU experience?
*
No
Yes
Can you lift 50-100lbs?
*
No
Yes
Are you proficient in discharge planning for PT?
*
No
Yes
Can you evaluate the nutritional status of individuals?
*
No
Yes
Do you have experience working with patients with wounds?
*
No
Yes
Do you have experience working with patients with edema?
*
No
Yes
Do you have experience with admitted patient?
*
No
Yes
Do you have outpatient experience?
*
No
Yes
Do you provide training and educate the patient and their loved ones?
*
No
Yes
Please supply an emergency contact name and phone number:
*
