New Jersey - Potential Strike
Submit Request
Infusion -Chemo
Requirements
:
BLS
Chemo
-- please complete this submission form honestly and accurately --
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 ONS Chemo 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 Chemo Infusion experience do you have?
*
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 Chemo Infusion in the past year?
*
No
Yes
What Facility have you worked Chemo Infusion at most recently?
*
Can you infuse chemo?
*
No
Yes
What chemo training have you had: ie, ONS, ONC, Hospital Trainings, etc?
*
Can you infuse Immunotherapy?
*
No
Yes
Can you infuse Blood?
*
No
Yes
Can you infuse antibiotics?
*
No
Yes
Can you access a port?
*
No
Yes
Can you start an IV?
*
No
Yes
Do you have BMT experience?
*
No
Yes
If you have BMT experience, do you administer stem cells?
No
Yes
Can you insert PICC lines?
*
No
Yes
Can you troubleshoot PICC lines?
*
No
Yes
Can you draw labs?
No
Yes
Do you have outpatient experience?
*
No
Yes
Do you have inpatient experience?
*
No
Yes
Please supply an emergency contact name and phone number:
*
Until what date can you work? (include the dates of any absences you may require)
*
