Potential California Strike
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Clinical Social Worker - ALLIED
Requirements
:
Masters Degree in Social Work
BLS
First Name
*
Last Name
*
Email
*
Phone
*
Are you a licensed Social Worker?
Yes
No
Do you have an active Clinical Social Worker license in California state?
Yes
No
Do you have a Marriage & Family Therapy license issued by California state?
Yes
No
Do you have a Professional Clinic Counselor license issued by California state?
Yes
No
What is your license number?
*
What is your license Expiration Date?
*
Do you have BLS certification?
*
No
Yes
List any other certification you have:
*
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 experience do you have as a licensed Social Worker?
*
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 done Social Work in the past year?
*
No
Yes
At what facility have you worked as a licensed Social Worker most recently?
*
What charting/EMR systems are you familiar with?
*
Are you experienced in Nephrology?
*
No
Yes
What settings are you experienced to work (hospital, clinic, nursing home, etc)?
How much experience do you have coordinating care for hospice patients?
*
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
Describe any experience you may have working in or supervising a mental health call center:
*
How much experience do you have with home social visits?
*
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
Are you comfortable driving to home visits on your own?
*
No
Yes
Are you comfortable using ride-share services (Uber, Lyft) for transportation to and from visits?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*