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First Name*

Last Name*

Email*

Phone*

Do you have an active Oregon Radiation Therapy license?*

No

Yes

What is your license number?*

Do you have BLS certification? *

No

Yes

Do you have ARRT license?*

No

Yes

If yes, what is your ARRT number?

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 Radiation Therapy experience do you have?*

Have you worked Radiation Therapy in the past year?*

No

Yes

What Facility have you worked in Radiation Therapy most recently?*

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

How much experience do you have in an Outpatient setting?*

Have you worked in any other settings or modalities? *

No

Yes

If so, how long and what type of setting or modality?*

Which brand equipment do you have experience with?*

Can you run a C-arm in the OR?*

No

Yes

Can you run fluoroscopy? *

No

Yes

If yes, what department have you worked Fluoroscopy in?

What type of radiation treatments have you administered?*

How much recent experience do you have with Varian software systems?*

Are you comfortable to educate patients and their loved ones about radiation therapy?*

No

Yes

Please supply an Emergency Contact name and phone number:*

NW - Potential Strike

Submit Request