Submit Request

First Name*

Last Name*

Email*

Phone*

Do you have BLS 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

What age patients are you comfortable caring for?*

At which Clinic or facility have you worked as a Radiology Aide most recently, and when?*

How much recent Radiology experience do you have?*

How much recent phone triage experience do you have?*

How much recent customer service experience do you have?*

Are you comfortable talking with patients over the phone and scheduling them for imaging procedures?*

No

Yes

What scheduling systems have you used?*

Can you educate patients on radiation?*

No

Yes

Can you assist with positioning?*

No

Yes

Can you assist with mould-making?*

No

Yes

How much recent Epic experience do you have?*

Please highlight any additional skills or unique experience you may have:

Please supply an emergency contact name and phone number:*

NW - Potential Strike

Submit Request