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First Name*

Last Name*

Email*

Phone*

Do you have an active Washington State license?*

What is your Washington State RN license #?*

License Expiration Date?*

Do you have BLS certification? *

No

Yes

Do you have PALS 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 PEDS Urgent Care experience do you have?*

Have you worked PEDS Urgent Care in the past year?*

No

Yes

What Facility have you worked PEDS Urgent Care at most recently?*

What clinic experience do you have?*

What inpatient experience do you have? *

Are you comfortable with phone triage calls?*

No

Yes

Are you comfortable assisting with Rx refills and Rx authorizations?*

No

Yes

Are you comfortable assisting scheduling appointments and resolving scheduling conflicts? *

No

Yes

Are you comfortable assisting in ordering home health equipment? *

No

Yes

Are you comfortable communicating between doctors/specialists offices? *

No

Yes

Are you comfortable assisting with calls regarding sick children?*

No

Yes

Are you proficient with Epic?*

No

Yes

Washington State - Potential Strike

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