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First Name*

Last Name*

Email*

Phone*

Do you have BLS certification? *

No

Yes

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 Endo Tech experience do you have?*

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

No

Yes

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

What Endo Tech training do you have?*

Can you clean and process scopes?*

No

Yes

Can you assist in bronchs (bronks)?*

No

Yes

Can you assist in E.R.C.P.s?*

No

Yes

Which brand of equipment are you experienced with?*

Can you label tissue specimens for Pathology?*

No

Yes

Can you handle hot and cold biopsies?*

No

Yes

How much experience in Pediatrics do you have?*

How much experience do you have with Endoscopic ultrasound?*

How much experience do you have with Esophageal dilation and Sclerotherapy?*

How much experience do you have with Peg placement?

How much experience do you have with Variceal banding?

Can you scrub in main OR? *

No

Yes

If yes, which cases can you scrub?

Oregon - Potential Strike

Endo Tech - Endoscopy