Your name
Your Email
Last 4 Of SSN
Date
E-Signature
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
Newborn/Neonate (birth–30 days): 0★★★★−
Infant (1 month–1 year): 0★★★★−
Toddler (1–3 years): 0★★★★−
Preschooler (3–5 years): 0★★★★−
School Age Child (5–12 years): 0★★★★−
Adolescents (12–18 years): 0★★★★−
Young Adults (18–39 years): 0★★★★−
Middle Adults (39–64 years): 0★★★★−
Older Adults (64–79 years): 0★★★★−
Elderly Adults (over 79+ years): 0★★★★−
Standard Precautions: 0★★★★−
Isolation Precautions: 0★★★★−
Pediatric Respiratory/Cardiac Arrest: 0★★★★−
Adult Respiratory/Cardiac Arrest: 0★★★★−
Crash Carts: 0★★★★−
Defibrillators: 0★★★★−
CT Planning: 0★★★★−
Hospital: 0★★★★−
Doctor's Office: 0★★★★−
Orthopedics: 0★★★★−
Surgery: 0★★★★−
Trauma: 0★★★★−
Ortho Voltage Radiation Treatment: 0★★★★−
Simulation of Treatment Sites: 0★★★★−
Cobalt 60 Therapy: 0★★★★−
Strontium 90 Therapy: 0★★★★−
Accelerator with Electrons: 0★★★★−
Calculations: 0★★★★−
Radiation Precautions: 0★★★★−
Hyperthermia Treatment: 0★★★★−
Linear Accelerator: 0★★★★−
Superficial Radiation Treatment: 0★★★★−
Block Cutting: 0★★★★−
Geometric Parameters: 0★★★★−
Patient Measurements: 0★★★★−
Venipuncture: 0★★★★−
Proton Beam: 0★★★★−
Neutron Beam: 0★★★★−
Brachytherapy Wires: 0★★★★−
Brachytherapy Seeds or Molds: 0★★★★−
Brachytherapy Rods: 0★★★★−
Interstitial Brachytherapy: 0★★★★−
Intraluminal Radiation Therapy: 0★★★★−
Intravenous Radioactively Tagged Molecules: 0★★★★−
I-131: 0★★★★−
Anal Cancer: 0★★★★−
Bone Cancer: 0★★★★−
Brain Cancer: 0★★★★−
Breast Cancer: 0★★★★−
Bladder Cancer: 0★★★★−
Cervical Cancer: 0★★★★−
Childhood Cancer: 0★★★★−
Colon Cancer: 0★★★★−
Esophageal Cancer: 0★★★★−
Endometrial Cancer: 0★★★★−
Gallbladder Cancer: 0★★★★−
Hodgkin’s and Other Lymphomas: 0★★★★−
Hypopharyngeal Cancer: 0★★★★−
Kidney Cancer: 0★★★★−
Laryngeal Cancer: 0★★★★−
Lip and Oral Cavity Cancer: 0★★★★−
Lung Cancer: 0★★★★−
Liver Cancer: 0★★★★−
Metastatic Squamous Cancer: 0★★★★−
Ovarian Cancer: 0★★★★−
Oropharyngeal Cancer: 0★★★★−
Penile Cancer: 0★★★★−
Pancreatic Cancer: 0★★★★−
Testicular Cancer: 0★★★★−
Uterine Cancer: 0★★★★−
Vaginal Cancer: 0★★★★−
Vulvar Cancer: 0★★★★−
Aria: 0★★★★−
Mosaiq: 0★★★★−
Telerad: 0★★★★−
Nighthawk: 0★★★★−
Please list the EMR systems you have used: