Potential Strike - Illinois
Submit Request
PEDS - RN
Requirements
:
Illinois RN license
BLS
PALS
-- 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?
*
No
Yes
Do you have PALS 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 ages are you comfortable with?
*
Can you take care of adults?
*
No
Yes
Can you work PICU or Peds step-down?
*
No
Yes
How much recent Neuro 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
Can you work NICU?
*
No
Yes
Have you worked in Peds oncology?
*
No
Yes
If yes, are you certified to infuse chemo?
No
Yes
How much recent experience do you have with NAS (neonatal abstinence syndrome)?
*
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 caring for children on chronic vents?
*
No
Yes
How much recent experience do you have with trachs?
*
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 start an IV?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*