Potential Strike - Washington
Submit Request
MS / Psych - RN
Requirements
:
Washington State or Multistate compact RN license
BLS
CPI or MAB certification
-- please complete this submission form honestly and accurately --
First Name
*
Last Name
*
Email
*
Phone
*
Do you have an active Washington state RN license?
*
No
Yes
If Yes, what is your Washington state RN license number?
If No, what is your Compact state and RN license number?
*
What is your RN License Expiration Date?
*
Do you have BLS certification?
*
No
Yes
Do you have CPI certification?
*
No
Yes
Do you have MAB certification?
*
No
Yes
Are you PMH-board certified?
*
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 Psych experience do you have?
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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 Psych in the past year?
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No
Yes
What Facility and City, state have you worked Psych most recenltly?
*
Have you been trained in MAB/CPI or any other assaultive behavior classes?
*
No
Yes
Can you lead groups?
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No
Yes
What ages can you care for?
*
Can you work in medical psych?
*
No
Yes
Can you work in geriatric psych?
*
No
Yes
Do you have pediatric or adolescent experience?
*
Yes
No
Do you have experience in a behavioral health Call Center?
*
Yes
No
How much experience do you have with ECT (electro convulsive therapy)?
*
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
How much recent EPIC 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
Please supply an Emergency Contact name and phone number:
*