New Jersey - Potential Strike
Submit Request
M/S Chemo - RN
Requirements
:
BLS
ACLS
Chemo /ONS
BMT (bone marrow transplant)
-- 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?
*
List your State and RN license number:
*
RN license expiration date:
*
Do you have BLS certification?
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No
Yes
Do you have ACLS certification?
*
No
Yes
Do you have BMT certification?
*
No
Yes
Do you have 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?
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No
Yes
Can you work a Day shift?
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No
Yes
Can you work a Mid shift?
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No
Yes
Can you work a Night shift?
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No
Yes
What is your Primary Shift preference?
*
Day
Mid
Night
100% Flexible
How many years MS Oncology Chemo 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 MS Oncology Chemo in the past year?
*
No
Yes
What Facility have you worked MS Oncology Chemo at most recently?
*
Do you access ports?
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No
Yes
What pediatric age group are you comfortable working or have you worked?
*
What adult population are you comfortable working or have you worked?
*
Have you worked in a Outpatient setting?
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No
Yes
Have you worked in a Inpatient setting?
*
No
Yes
Do you have BMT experience?
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No
Yes
Can you administer stem cells?
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No
Yes
Can you start an IV?
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No
Yes
Can you insert PICC lines?
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No
Yes
Can you troubleshoot PICC lines ?
*
No
Yes
Please supply an Emergency Contact name and phone number:
*
Until what date are you able to work? (include the dates of any absences you may require)
*
