Potential Strike - Illinois
Submit Request
PEDS Chemo - RN
Requirements
:
Illinois RN license
BLS
PALS
APHON
-- 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
Do you have APHON 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
How many years Peds Oncology Chemo 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
Have you worked Peds Oncology Chemo in the past year?
*
No
Yes
What Facility have you worked Peds Oncology Chemo at most recently?
*
What pediatric age group are you comfortable working or have you worked?
*
How much recent transplant 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
Do you access ports?
*
No
Yes
Have you worked in a Outpatient setting?
*
No
Yes
Have you worked in a Inpatient setting?
*
No
Yes
Do you have BMT experience?
*
No
Yes
Can you administer stem cells?
*
No
Yes
Can you start an IV?
*
No
Yes
Can you insert PICC lines?
*
No
Yes
Can you troubleshoot PICC lines ?
*
No
Yes
What types of infusion are you able to perform other than Chemotherapy, if any?
*
Please supply an Emergency Contact name and phone number:
*
