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First Name*

Last Name*

Email*

Phone*

Do you have an active California license?*

What is your California RN license number?*

License Expiration Date?*

Do you have BLS certification? *

No

Yes

Do you have an 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 much recent Procedural Sedation experience do you have?*

How much recent Endo experience do you have?*

Do you have experience with Bronchs?*

No

Yes

Do you have pre/post-op experience?*

No

Yes

How much recent experience do you have cleaning and processing scopes?*

What age range of patients are you comfortable caring for?*

Please supply an Emergency Contact name and phone number:*

Procedural Sedation - RN (California)