Potential Strike
New Jersey
submit request
IR Scrub Tech
Requirements
:
BLS
NBSTSA-CST Surgical Tech Certification
-- please complete this form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an NBSTSA-CST certification?
*
No
Yes
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
How many years experience do you have as an IR Tech?
*
None
6 Months or less
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
More than 10 Years
Have you worked as an IR Tech in the past year?
*
No
Yes
What Facility, city and state, have you worked as an IR Tech most recently?
*
In which hospital units are you most comfortable working?
*
What kinds of diagnoses do you have experience treating?
*
What kind of equipment do you have experience working with?
*
What age range of patients are you comfortable caring for?
*
Do you have inpatient or outpatient experience?
*
Inpatient
Outpatient
Both
Do you have home health experience?
*
No
Yes
Do you scrub open-heart?
*
No
Yes
Do you scrub CABG?
*
No
Yes
Do you scrub triple-A?
*
No
Yes
Do you assist with PICC line?
*
No
Yes
Do you assist with drains and complex wound dressings?
*
No
Yes
Do you assist with conscious sedation recovery?
*
No
Yes
Describe any other duties you assist with or cases you typically scrub:
*
Please supply an Emergency Contact name and phone number:
*
Until what date can you work? (include the dates of any absences you may require)
*
