Submit Request

First Name*

Last Name*

Email*

Phone*

Are you a registered CNA in Washington state?*

No

Yes

What is your CNA registry number and State?*

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 CNA?*

Have you worked as a CNA in the past year?*

No

Yes

At what facility have you worked as a CNA most recently?*

How much experience do you have in a hospital setting?*

What type of clinic settings have you worked, if any?

Do you have inpatient experience or outpatient experience, or both?*

Inpatient

Outpatient

Both

Describe any Pharmacy experience you may have:*

Please supply an Emergency Contact name and phone number:*

NW - Potential Strike