Potential Strike - Illinois
Submit Request
Clinic - Cardiac - RN
Requirements
:
Illinois RN license
BLS
ACLS
moderate sedation experience
T.E.E. experience (preferred)
-- please complete this submission form honestly and accurately --
First Name
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Last Name
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Email
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Phone
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Do you have an active Illinois RN license?
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No
Yes
List your RN license number:
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RN license expiration date:
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Do you have BLS certification?
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No
Yes
Do you have ACLS certification?
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No
Yes
List any other certification you have:
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What specialties do you float to?
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Do you have the COVID Vaccination?
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No - Requesting Exemption
Yes - Vaccinated
Yes - Vaccinated with Booster
Typically for strike assignments: 5x12/hr shifts (60/hrs week) Are you ok with this?
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No
Yes
Do you have Charge Nurse Experience?
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No
Yes
Can you work a Day shift?
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No
Yes
Can you work a Mid shift?
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No
Yes
Can you work a Night shift?
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No
Yes
What is your Primary Shift preference?
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Day
Mid
Night
100% Flexible
How many years Primary Care Clinic experience do you have?
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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 Primary Care Clinic in the past year?
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No
Yes
At which Clinic have you worked Primary Care most recently?
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What clinic settings do you have experience working in?
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What age patients are you comfortable caring for?
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Can you perform allergy scratch testing?
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No
Yes
How much recent experience do you have with D.O.T. physicals?
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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
How much recent experience do you have drawing blood?
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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
How much recent experience do you have administering shots?
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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
How much recent experience do you have completing 12-lead EKG?
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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
How much recent experience do you have with Moderate Sedation?
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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
How much recent experience do you have with T.E.E.?
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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
What other outpatient testing can you perform?
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Can you start an IV?
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No
Yes
In which settings do you have experience and are comfortable to specialize? (select all that apply)
Allergy
Apheresis
Chemo Infusion
Cardiac/Heart Failure
Cardiac/Thoracic/Vascular
Cardiology
Cystic Fibrosis
Dermatology
Diabetes
Digestive Disease
Ear/Nose/Throat
Endocrinology
Gastroenterology
Geriatric
GI
Infectious Disease
Infertility
Infusion
Medical
Neurology
Neurosurgery
OBGYN
Oncology
Orthopedic
Pain Clinic
Pediatric
Primary Care
Psychiatric Care
Pulmonary Op
Radiation Oncology
Rheumatology
Urology
Urogynecology
Womens Specialties
Please highlight any additional clinical skills or unique experience you may have:
Please supply an emergency contact name and phone number:
*