Potential Strike - Illinois

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MS / Tele Chemo - RN

Requirements:

Illinois RN license
BLS
ACLS
ONC Chemotherapy certification
PALS (preferred)

-- please complete this submission form honestly and accurately --

First Name*

Last Name*

Email*

Phone*

Do you have an active Illinois RN license?*

RN license number:*

RN license expiration date:*

Do you have BLS certification? *

Yes

Do you have ACLS certification?*

Yes

Do you have Chemo certification?*

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?*

Yes

Do you have Charge Nurse Experience?*

Yes

Can you work a Day shift?*

Yes

Can you work a Mid shift?*

Yes

Can you work a Night shift?*

Yes

What is your Primary Shift preference?*

Day

Mid

Night

100% Flexible

How many years MS Oncology Chemo do you have?*

Have you worked MS Oncology Chemo in the past year?*

Yes

What Facility have you worked MS Oncology Chemo at most recently?*

Do you access ports?*

Yes

What pediatric age group are you comfortable working or have you worked?*

What adult population are you comfortable working or have you worked?*

Have you worked in a Outpatient setting?*

Yes

Have you worked in a Inpatient setting?*

Yes

Do you have BMT experience? *

Yes

Can you administer stem cells?*

Yes

Can you start an IV?*

Yes

Can you insert PICC lines?*

Yes

Can you troubleshoot PICC lines ?*

Yes

What types of infusion are you able to perform other than Chemotherapy, if any?*

Please supply an Emergency Contact name and phone number:*