Telemetry

Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform) 3 = Proficient/can perform independently 4 = Expert/very experienced in the field

Recruiter Information

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Acknowledgment

Please read and agree to the statements below by marking the checkbox. I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities

Telemetry

Recruiter Information

Personal Information

Pulmonary

Gastrointestinal

Neurologic & Psychiatric

RENAL/GENITOURINARY

ENDOCRINE METABOLIC

MEDICATIONS

CARDIAC MONITORING & EMERG. RESPONSE

IV THERAPY

PROFESSIONAL KNOWLEDGE AND SKILLS

Acknowledgment

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