Operating Room RN

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

Recruiter TEEMA email

Personal Information

Full Name

Your Email

Your phone number

Last 4 of Social Security Number

Certification

BCLS (Exp. Date)

CNOR (Exp. Date)

ACLS (Exp. Date)

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

Operating Room RN

Recruiter Information

Personal Information

Ear, Nose & Throat

General Surgery

Gynecology

Neurology

Ophthalmology

Orthopedics

Plastics

Thoracic & Open Heart

Urology

Vascular

Equipment

Phlebotomy/IV Therapy

Age Specific Criteria

Experience With Age Groups

Certification

Acknowledgment

Office

Canadian Headquarters

US Headquarters

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