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First Name*

Last Name*

Email*

Phone*

Do you have BLS certification? *

No

Yes

Do you have ACLS certification?*

No

Yes

Do you have ARRT certification?*

No

Yes

Do you have a CRT certification?*

No

Yes

Do you have a Fluoroscopy certification?*

No

Yes

List any other certification you have:*

What specialties do you float to?*

Do you have the COVID Vaccination?*

No - Requesting Exemption

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 Cath Lab Tech?*

Have you worked as a Cath Lab Tech in the past year?*

No

Yes

At what facility have you worked as a Cath Lab Tech most recently?*

Have you worked as a Rad Tech in the past year?*

No

Yes

Can you work EP?*

No

Yes

How much recent experience do you have in an EP lab?*

How many years Rad Tech experience do you have?*

How many years of Interventional Cardiovascular experience do you have?*

What other settings or modalities have you worked as a Rad Tech? *

Do you have experience operating EKG machines?*

No

Yes

Can you Scrub?*

No

Yes

Can you deploy closure devices?*

No

Yes

What ages are you comfortable caring for?*

How much recent experience do you have with IVUS?*

How much recent experience do you have in extremity cases?*

Can you pull arterial sheaths?*

No

Yes

Can you perform a medicated stress test?*

No

Yes

How much recent experience do you have assisting with T.E.E.?*

How much recent experience do you have with TAVRs?*

Please supply an Emergency Contact name and phone number:*

NW - Potential Strike

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