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First Name*

Last Name*

Email*

Phone*

Do you have an active California RN license?*

No

Yes

California 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 experience Cardio Stress Testing do you have?*

Have you worked Cardio Stress Testing in the past year?*

No

Yes

What Facility and City, state have you worked Cardio Stress Testing most recently?*

How much recent experience do you have with applying and troubleshooting Holter monitoring? *

How much recent experience do you have with implanted Pacemakers? *

How much recent experience do you have with A.I.C.D.s? *

AICD = automatic implantable cardioverter defibrillator

How much recent experience administering cardiac vasodilators during a chemical stress test?*

Can you start an IV?*

No

Yes

California - Potential Strike

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