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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 WOCN certification?*

No

Yes

Which wound care certification do you have?*

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 Wound Care experience do you have?*

Have you worked Wound Care in the past year?*

No

Yes

What Facility have you worked Wound Care at most recently?*

Which age of patient needing wound care are able to care for?*

How much recent experience do you have with performing debridement? *

How much recent experience in wound wrapping do you have? *

How much recent experience do you have with biological grafting? *

How much recent experience do you have with hyperbaric oxygen treatments? *

If hyperbaric experience, what was your role in the treatment?

Have you provided wound care treatment in inpatient settings?*

No

Yes

Have you provided wound care treatment in outpatient settings?*

No

Yes

Can you start an IV?*

No

Yes

Are you able to set up a wound care vac? *

No

Yes

If yes, are you able to change the dressing on a wound care vac?

No

Yes

If yes, are you able to change the drainage container on a wound vac?

No

Yes

California - Potential Strike

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