New York - Potential Strike
Submit Request
Hemodialysis - RN
Requirements
:
BLS
ACLS
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active New York RN license?
*
What is your New York RN license #?
*
RN 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 Hemodialysis experience do you have?
*
None
6 Months or less
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
More than 10 Years
Have you worked Hemodialysis in the past year?
*
No
Yes
What Facility have you worked Hemodialysis at most recently?
*
Do you have Inpatient experience?
*
No
Yes
Do you have Outpatient experience?
*
No
Yes
Which machines have you used?
*
Can you perform peritoneal dialysis?
*
No
Yes
Do you have any plasma pheresis experience?
*
No
Yes
Have you worked with and managed hemodialysis techs?
*
No
Yes
Can you clean the machines?
*
No
Yes
Are you comfortable taking call for any and all dialysis emergencies?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*
