Default Confirmation

<p>This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Fusion Medical Staffing.</p>

<ul class="key">

    <li>0 = Not Applicable</li>

    <li>1 = No Experience</li>

    <li>2 = Some Experience</li>

    <li>3 = Intermittent Experience</li>

    <li>4 = Experienced</li>

    <li>5 = Very Experienced</li>
    
</ul>

<p class="required-fields">*Required fields</p>


<div class="checklist-header">
        <table>
            <tr>
               <th>Age of Patients Cared For</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

<div class="checklist-header">
        <table>
            <tr>
               <th>GENERAL SKILLS</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

<div class="checklist-header">
        <table>
            <tr>
               <th>SETTING</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

<div class="checklist-header">
        <table>
            <tr>
               <th>Diagnostic Studies/Procedures</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

<div class="checklist-header">
        <table>
            <tr>
               <th>Monitoring/Scoring</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

<div class="checklist-header">
        <table>
            <tr>
               <th>Equipment</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

<div class="checklist-header">
        <table>
            <tr>
               <th>Credentials</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

<div class="checklist-header">
        <table>
            <tr>
               <th>Other Skills</th>
               <th class="cell">0</th>
               <th class="cell">1</th>
               <th class="cell">2</th>
               <th class="cell">3</th>
               <th class="cell">4</th>
               <th class="cell">5</th>
            </tr>
        </table>
</div>

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.

<p class="note">The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.<p>

Attach to Email Notification

Admin Notification - Cath

New submission from {form_title}

QA Testing

Skills Checklist - Polysomnographer/Sleep Tech

Anesthesia Technician

Dietitian

EEG Technician

EKG Technician 

Perfusionist

Polysomnographer/Sleep Tech

RRT/CRT

Director of Cardiac Cath Lab

Manager of Cardiac Cath Lab

Cath Lab RN

Cath Lab Tech

Director of Electrophysiology EP Lab

Manager of Electrophysiology EP Lab

EP RN

EP Tech

Director of Interventional Radiology IR Lab

Manager of Interventional Radiology IR Lab

IR RN

IR Tech

Cytotechnologist

Histology Manager

HT/HTL

Lab Assistant

Laboratory Director

Laboratory Manager

MT/MLT

Pathologist Assistant

Phlebotomy General

Point of Care Coordinator

LTC RN

LTC Director of Nursing

MDS Coordinator

Medication Aid

Vaccine Administrator LPN

Home Health RN

Hospice RN

Home Health LPN

Hospice LPN

Home Infusion RN

Home Health Clinical Manager 

Ambulatory RN

Postpartum RN

Behavioral Health RN

Case Management

Certified Surgical First Assistant

CVOR RN 

CVOR Tech

Dialysis RN

Dialysis Tech

Director of Nursing

Endoscopy RN

Endoscopy Tech

ER RN

House Supervisor

Infection Prevention RN

Intensive Care RN

Infusion RN 

Labor and Delivery RN

LTAC RN

Medical Surgical/ Telemetry

Neonatal Intensive Care

Nurse Manager

OB Tech

Oncology

OR RN

PACU

Pediatric Emergency Room

Pediatric Intensive Care

Pediatric RN

Rehab RN

Sterile Processing Technologist

Surgical Tech

Tele, PCU, Stepdown RN

Transplant Coordinator RN

Vaccine Administrator RN

Director of Radiology

Radiology Manager

Diagnostic Radiology RN

Dosimetrist

Mammography Technologist

Nuclear Medicine Technologist

Medical Physicist

Radiation Therapist

Ultrasound

X-Ray Tech

OT/COTA

Director of Rehabilitation

Therapy Director

Outpatient Therapy Manager

Fusion Medical

We have the Skills Checklist here that you need for your specific Specialty! After you've filled out a Quick or Full Application, feel free to take that next step right away and fill out your specific skills checklist.

Skills Checklist - Fusion Medical

We have the Skills Checklist here that you need for your specific Specialty! After you&#039;ve filled out a Quick or Full Application, feel free to take that next step right away and fill out your specific skills checklist.

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Polysomnographer/Sleep Tech - Fusion Medical

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Polysomnographer/Sleep Tech