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Clinical Candidate Questionnaire
Clinical Candidate Questionnaire
Chris Harrell
2024-12-11T21:19:59-06:00
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Name
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First
Last
Email
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Position applying for:
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Medical Assistant
Licensed Vocational Nurse
Registered Nurse
What license / certification do you currently hold?
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Medical Assistant
Licensed Vocational Nurse
Registered Nurse
Other
RN License State and Number:
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LVN License State and Number:
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CMA Certification State and Number:
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Is your BLS / PALS certification current?
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Yes
No
Are you seeking full or part-time employment?
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Part-time
Full-time
Are you able to work two (2) weekends per month (Saturday: 9am-1pm & Sunday: 2-5pm)?
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Yes
No
Are you available to work 8:00am-6:00pm Monday-Friday (Part-Time: 2-3 days per week; Full-Time: 4 days per week)?
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Yes
No
Are you available to work on holidays?
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Yes
No
Do you require any specific days off?
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Yes
No
If yes, please explain:
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Hourly compensation you are looking for?
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Core Skill Competencies
Select all skills which you are proficient.
Core Skills - Assessment Skills
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Taking VS
Orthostatic Blood Pressure
4 Extremity Blood Pressure
Temporal Temperature
Head Circumference
Length of Child, greater than 3 years
Length of Infant, less than 12 months
Pre and Post Ductal Pule Oximetry
Pulse Oximetry
Scoring an Asthma Control Test Questionnaire
Scoring Ages and Stages Developmental Questionnaire
Plot Height / Weight / Head Circumference on Growth Chart
Audio Screenings
Spot Vision Screenings
Core Skills - Procedures
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I&D Abscess
Ear Irrigation
Wound Irrigation
Wart Cryotherapy
Suture Placement Assistance
Staple placement Assistance
Dermabond Placement Assistance
Fluoroscein Corneal Abrasion Evaluation Assistance
Circumcision Assistance
Interpreting Pulmonary Function Testing
Composing Personalized Asthma Action Plans
Core Skills - Immunizations
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Administer IM Vaccinations
Administer SQ Vaccinations
Draw Up Vaccinations
Proper Storage of Vaccinations
Blood Draw
Capillary Draw Finger Stick
Capillary Blood Draw Heal Stick
Venous Blood Draw
Cath Urine Sample
IV Placement
Core Skills - Ear Piercing
Pierce Ears
Core Skills - Splinting
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Reading Radiographs for Fractures
Forearm Single Sugartong
Forearm Double Sugartong
Ulnar Gutter
Forearm Posterior
Lower Leg Posterior
Sling and Sloth
Core Skills - Technology
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Microsoft Word
Using email, such as Gmail
Use of simple applications on an iPad
None of the above
List Electronic Medical Record Programs you have used:
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How comfortable are you with the appointment types below?
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Enjoy Most
Proficient
Needs Updating
Not Comfortable
Unsure
Ear Pain
Sore Throat / Strep Throat
Rash
Abscess Requiring I&D
Otitis Media
Otitis Externa
Viral Exanthem
RSV Bronchiolitis
Gastroenteritis
Atopic Dermatitis
Migraines
Viral Upper Respiratory Tract Infections
Urinary Tract Infections
Asthma Exacerbation
Newborn Care
Wellness Care (< 2 yrs)
Wellness Care (2-18 yrs)
Are you up-to-date on vaccines?
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Yes
No
Have you had a PPD test, for tuberculosis, in the past 12 months?
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Yes
No
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