Potential Strike - Illinois
Submit Request
Dialysis - RN
Requirements
:
Illinois RN license
BLS
BONENT Hemodialysis certification (preferred)
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active Illinois RN license?
*
No
Yes
RN license number:
*
RN license expiration date:
*
Do you have BLS certification?
*
No
Yes
Do you have a BONENT Hemodialysis 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 Nurse Experience?
*
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
What age range of patients are you comfortable caring for?
*
How much recent experience do you have working Dialysis?
*
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 peritoneal dialysis?
*
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 plasma pheresis?
*
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
Can you set up, take down, and troubleshoot the circuit on a CRRT machine?
*
No
Yes
Which machine brands do you have experience with?
*
Do you clean the machines?
*
No
Yes
Is your experience in an inpatient setting or outpatient?
*
Inpatient
Outpatient
Both
Please supply an Emergency Contact name and phone number:
*
