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First Name*

Last Name*

Email*

Phone*

Do you have an active New Jersey or Multistate Compact RN license?*

No

Yes

List your State and RN license number:*

RN license expiration date:*

Do you have BLS certification? *

No

Yes

Do you have ACLS 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

Do you have Charge Nurse Experience?*

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 Echo experience do you have?*

Have you worked as an Echo RN in the past year?*

No

Yes

What Facility and City, state have you worked as an Echo RN most recently?*

How much recent experience do you have with the four phases of cardiac rehab?*

Can you teach cardiac rehab classes?*

No

Yes

Can you perform exercise testing?*

No

Yes

Can you perform a cardiac echo?*

No

Yes

Can you perform OB ultrasound?*

No

Yes

Which specializations are you most comfortable with?*

Can you perform and interpret a 12-lead EKG?*

No

Yes

Are you experienced assisting with Cardioversion?*

No

Yes

Can you assist with T.E.E. (transesophageal echocardiogram)?*

No

Yes

Can you start an IV?*

No

Yes

Please supply an Emergency Contact name and phone number:*

If the strike extends indefinitely, until what date can you work? (include any time off you require)*

Echo Lab - RN