New York - Potential Strike

Submit Request

Emergency Room

Requirements:

BLS
ACLS (preferred)
PALS (preferred)
TNCC (preferred)

-- please complete this submission form honestly and accurately --

First Name*

Last Name*

Email*

Phone*

Do you have an active New York RN license?*

No

Yes

What is your New York license #?*

License Expiration Date?*

Do you have BLS certification? *

No

Yes

Do you have ACLS certification?*

No

Yes

Do you have PALS certification?*

No

Yes

Do you have TNCC 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 ER experience do you have?*

How much, if any, PEDS ER experience do you have?*

Have you worked in the ER in the past year?*

No

Yes

What Facility and City, State have you worked ER at most recently?*

What level ER are you the most comfortable in? (Level 1 is the highest)*

Have you worked in an ER trauma room?*

No

Yes

Can you transport via ambulance?

No

Yes

Can you transport via helicopter?

No

Yes

Can you transport NICU/PICU?

No

Yes

Can you transport patients on ECMO?

No

Yes

Can you transport patients on VAD?

No

Yes

Can you transport patients on Vents?

No

Yes

Can you transport patients on Balloon Pumps?

No

Yes

Do you have burn experience?

No

Yes

Can you start an IV?

No

Yes

Can you work in Triage or Fast track?

No

Yes

Please supply an Emergency Contact name and phone number:*