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First Name*

Last Name*

Email*

Phone*

Do you have BLS certification? *

No

Yes

Do you have a current EKG tech certification? *

No

Yes

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 an EKG Tech?*

Have you worked as an EKG Tech in the past year?*

No

Yes

At what facility have you worked as an EKG Tech most recently?*

Can you perform a 12-lead EKG?*

No

Yes

Can you perform a right heart EKG?*

No

Yes

Can you assist with cardiac stress testing?*

No

Yes

How much experience do you have rooming patients for X-ray exams?*

How much experience do you have doing clerical work?*

Are there any other departments or units you work in?*

Do you have experience with temporary pacemakers?*

No

Yes

Do you have experience with permanent pacemakers?*

No

Yes

Do you have experience with Defibrillators?*

No

Yes

Do you have experience with event monitors?*

No

Yes

Can you interpret EKGs?*

No

Yes

Can you identify lethal rhythms?*

No

Yes

How much experience do you have applying and managing Holter Monitors?*

Are you proficient to perform Holter Monitor tests?*

No

Yes

Please supply an Emergency Contact name and phone number:*

NW - Potential Strike

Submit Request