New York - Potential Strike

Submit Request

Psych

Requirements:

BLS
MAB or CPI

-- 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 CPI certification?*

No

Yes

Do you have MAB certification?*

No

Yes

Are you PMH-board certified?*

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 Psych experience do you have?*

Have you worked Psych in the past year?*

No

Yes

What Facility and City, state have you worked Psych most recenltly?*

Have you been trained in MAB/CPI or any other assaultive behavior classes?*

No

Yes

Can you lead groups?*

No

Yes

What ages can you care for?*

Can you work in medical psych?*

No

Yes

Can you work in geriatric psych?*

No

Yes

Do you have pediatric or adolescent experience?*

Yes

No

Are you PMH-board certified?*

Yes

No

How much experience do you have with ECT (electro convulsive therapy)? *

Please supply an Emergency Contact name and phone number:*