Michigan Submit Request

First Name*

Last Name*

Email*

Phone*

Do you have BLS certification? *

No

Yes

Do you have NBSTSA CST certification?*

No

Yes

If yes, what is your NBSTSA number?

List any other certification you have:*

What specialties do you float to?*

Do you have the COVID Vaccination?*

No

Yes - Vaccinated

Yes - Vaccinated with Booster

Typically for strike assignments: 5x12/hr shifts (60/hrs week) Are you ok with this?*

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 CVOR Tech experience do you have?*

Have you worked as an CVOR Tech in the past year?*

No

Yes

What Facility \ have you worked as an CVOR Tech most recently?*

Which types of can you scrub outside of CVOR?*

Can you scrub CABG?*

No

Yes

Can you scrub Valves?*

No

Yes

Can you scrub Triple A?*

No

Yes

Can you scrub TAVRs?*

No

Yes

Can you scrub peds open heart?*

No

Yes

Can you scrub heart and lung transplants?*

No

Yes

Can you first assist?*

No

Yes

If yes, are you First Assist Certified?*

No

Yes

If you can first assist, which type of cases can you assist in?

List any equipment you have experience with not listed above:

Michigan - Potential Strike

Submit Request