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First Name*

Last Name*

Email*

Phone*

Do you have an active California license?*

What is your California RN license #?*

License Expiration Date?*

Do you have BLS certification? *

No

Yes

Do you have ACLS 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

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 Cath Lab experience do you have?*

Have you worked Cath Lab in the past year?*

No

Yes

What Facility have you worked Cath Lab at most recently?*

How many years EP Lab experience do you have?*

How much recent experience do you have in an EP lab?*

Can you circulate?*

No

Yes

Can you Scrub?*

No

Yes

Can you Monitor?*

No

Yes

Can you document?*

No

Yes

What ages are you comfortable caring for?*

How much recent experience do you have with IVUS?*

How much recent experience do you have in extremity cases?*

How much recent experience do you have with balloon pumps? *

Can you set it up and maintain a patient on a balloon pump?*

No

Yes

How much recent experience do you have with Impella Heart Pumps?*

How much recent experience do you have in Watchman Implant cases?*

Can you pull arterial sheaths?*

No

Yes

Can you perform a medicated stress test?*

No

Yes

How much recent experience do you have performing NIPS?*

(Non-Invasive Program Stimulation Testing of ICD's)

How much recent experience do you have assisting with T.E.E.?*

How much recent experience do you have with TAVRs?*

California - Potential Strike

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