Oregon - Potential Strike
Submit Request
Dialysis RN
Requirements
:
BLS
ACLS
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active Oregon RN license?
*
No
Yes
What is your active RN license number?
*
What is your RN license expiration date?
*
Do you have BLS certification?
*
No
Yes
Do you have an 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
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 experience do you have as a Dialysis RN?
*
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 as a Hemodialysis RN in the past year?
*
No
Yes
At what facility have you worked as a Hemodialysis RN most recently?
*
How many years experience do you have with Inpatient dialysis?
*
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
How many years experience do you have with outpatient dialysis?
*
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
Which machines have you used, and do you clean them?
*
When is the last time you performed peritoneal dialysis, and what types?
*
How much plasma pheresis 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
Please provide an Emergency Contact name and phone number:
*