New York - Potential Strike

Submit Request

OR Dental / Ophthalmology

Requirements:

BLS
ACLS

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

First Name*

Last Name*

Email Address*

Phone*

Do you have an active NY RN license?*

No

Yes

What is your NY license #?*

License expiration date?*

Do you have BLS certification? *

No

Yes

List any other certification you have:*

What other 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

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

Do you have charge nurse experience?*

No

Yes

Have you worked in an Inpatient setting?*

No

Yes

Have you worked in an Outpatient setting?*

No

Yes

What specialty/cases do you circulate most?*

Can you scrub?*

No

Yes

If so, which cases?

Can you circulate and/or scrub in the open heart room?*

No

Yes

Do you have experience with PEDS OR?*

No

Yes

Which eye cases can you circulate?*

How much robotic experience do you have?*

None

Minimal

Regularly

Daily

If so, which model? Davinici? Mazur?

Do you have Neuro/Crani experience?*

No

Yes

Can you circulate organ transplants?*

No

Yes

If so, which ones?

How much experience do you have with organ or tissue harvest?*

None

Minimal

Regularly

Daily

Are you able to implement malignant hyperthermia protocols?*

No

Yes

How much Endo experience do you have?*

None

Minimal

Regularly

Daily

Do you have current Trauma OR experience?*

No

Yes

What experience do you have in oral and maxillofacial surgery?*

What experience do you have with facial, jaw or mouth trauma experience?*

What experience do you have with cleft lip or cleft palate surgery?*

Please supply an Emergency Contact name and phone number:*