Five Star Care Application
Acute Care Division
Name
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First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Email
*
example@example.com
In which state are you available to work?
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NJ
PA
How many miles are you willing to travel?
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I am a(n):
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Certified Medical Assistant (CMA)
Licensed Practical Nurse (LPN)
Registered Nurse (RN)
Research Pharmacist
Scribe
Technician (or CNA)
As an RN, which dept(s) do you want to work in? (min 1 year prior exp a MUST!))
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Catheterization Laboratory (Cath Lab)
Critical Care Unit (CCU)
Dialysis department
Emergency Department (ED)
Intensive Care Unit (ICU)
Labor and Delivery (L & D)
Medical Surgical (Med-Surg)
Newborn Intensive Care Unit (NICU)
Operating Room (OR)
Pediatric Department (Peds)
Pediatric Intensive Care Unit (PICU)
Pediatric Oncology Unit
Post Anesthesia Care Unit (PACU)
Telemetry department
What type of Tech are you?
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Cardiovascular Tech
Central Supply Tech
Dialysis Tech
OB Tech
Patient Care Tech/ CNA
Pharmacy Tech
Radiology Tech
Surgical Tech
Ultrasound Tech
Are you a Certified OB Tech?
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Yes
No
As a OB Tech, select all that applies to you.
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I have more than 1 year experience
I have Acute Care experience
I am BLS-AHA certified
I have PCT experience
As a Patient Care Tech, select all that applies to you.
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I have more than 1 year experience
I have Acute Care experience
I am BLS-AHA certified
I have PCT experience
I have Emergency Room experience
Are you a Certified Pharmacy Tech?
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Yes
No
As a Pharmacy Tech, select all that applies to you.
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Certified Pharmacy Tech
Completed High School (Diploma or GED)
Hospital experience
Omnicell experience
PTCB
Are you a Certified Medical Assistant?
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Yes
No
As a Medical Assistant, select all that applies to you.
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Certified Medical assistant
High school diploma
Graduate of a CAAHEP or ABHES accredited Medical Assistant program
Excel experience
EMR experience
Office experience
Are you a Certified Ultrasound Tech?
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Yes
No
As an Ultrasound Tech, select all that applies to you.
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Certified Ultrasound Tech
CCI Certified
ARDMS Certified
Experienced in Perinatology
Experienced in Maternal Fetal Medicine
Experienced in Nuchal Translucency Ultrasounds
Experienced in Bone Marrow Ultrasounds
Are you a Certified Radiology Tech?
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Yes
No
As a Radiology Tech, select all that applies to you.
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OR experience
AART certified
X-ray experience
Certified Radiologic tech
BLS certified
NJ Dep license
Are you a Certified Surgical Tech?
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Yes
No
As a Surgical Tech, select all that applies to you.
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Certified OR tech
OR Trauma Level 1
OR Trauma Level 2
Multi service line OR
Vascular surgery
Robotic surgery
Ortho surgery
Are you a Certified Cardio Tech?
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Yes
No
As a Cardio Tech, select all that applies to you.
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RCIS exam given by CCI or Radiologic Technologist License
Rad Tech
ART certified
BLS certified
ACLS certified
I have my Radiology certification
Experienced in the Cath Lab
Experienced in Sterile Operative Techniques
Experienced in Hemodynamic Monitoring
Experienced with Impelle pump insertion
Experienced in Electrophysiology
Experienced in MACLAB
Experienced with Pace Makers
Experienced with Cath procedures
As a Research Pharmacist, select all that apply to you.
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I have experience as a Research pharmacist
I am trained in EPIC
I am CITI (Collaborative Institutional Training Initiative) trained
Beacon
As a Cath Lab nurse, select all that apply to you.
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2+ years experience
Experienced in Hemodynamics
Experienced in Balloon pumps
Experienced in Circulating
Experienced in the ER dept
Experienced in Cardiac dept
Experienced in the ICU dept
I have a CCRN license
I am trained in EPIC
I am familiar with Sensis
As a CCU RN, select all that apply to you.
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Critical care unit experience
Step down unit experience
As a Dialysis RN, select all that apply to you.
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ICH (In- Center Hemodialysis)
As an ED RN, select all that apply to you.
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ACLS certified
BLS certified
CEN certified
CPEN certified
CPOE certified
NIHSS certified
PALS certified
TNCC certified
Experienced in Express Care
Experienced in Pediatrics
Experienced in Behavioral Health
Experienced with Strokes
Experienced in Critical Care
Experienced with Critical Care Drips
Experienced with Vents
Experienced in the ICU
Experienced with Stemi patients
Trained in EPIC
As an L&D RN, select all that apply to you.
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BCLS-AHA certified
NRP certified
1 year experience in L&D
2 years experience in L&D
Trained in EPIC
Can circulate to the OR
National Certification in Mother/ Baby
NCC in Electronic Fetal Monitoring or AWOHNN certified
1 year experience in experienced in Mother Baby unit
2 years experience in experienced in Mother Baby unit
Experienced in the Nursery
As a Medsurg RN select all that apply to you:
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BLS certified
ACLS certified
Telemetry certification
Medsurg certification
Medsurg experience
EPIC experience
Telemetry experience
As a NICU RN select all that apply to you
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Level 3 NICU
BCLS certified
NRP certified
As an OR nurse select all that apply to you
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CNOR certified
ICU experience
OR trauma level 1 & 2 experience
Multi line experience
Medsurg experience
OR experience
Neurosurgery experience
Robotics procedure experience
Endovascular surgery experience
Orthopedic experience
Vascular surgery experience
EPIC experience
As an PACU nurse, select all that apply to you.
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I am PALS-AHA certified
I am ACLS-AHA certified
I am BLS-AHA certified
As a Pediatric nurse, select all that apply to you.
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Pediatric experience
I can float to PICU
I have EPIC experience
I have chemo experience
As a Pediatric Oncology nurse select all that apply to you
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Oncology experience
Pediatric nurse experience
Hematology experience
Biotherapy experience
Chemotherapy experience
APHON certified
As a PICU nurse select all that apply to you
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PICU Skills
As a Tele nurse select all that apply to you
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Valid RN license
Cath lab experience
ACLS & BLS certified
Tele experience
Medsurg experience
Tube feedings experience
Central lines experience
TPN experience
Basic IV drips experience
Stroke experience
Tele neuro experience
Stepdown experience
EPIC experience
Which shift are you looking to work?
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Day
Night
Per Diem Days
Per Diem Nights
When are you ready to start working?
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-
Month
-
Day
Year
Date
My target hourly rate is:
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Have you worked at a Hackensack Meridian Health facility in the last 6 months
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Yes
No
I'm not sure
Have you worked at an Atlantic Health system facility within the last 6 months?
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Yes
No
I'm not sure
How did you hear about us?
Is there anything else you would like us to know?
Please attach your UPDATED resume. Experience in the field is a MUST.
*
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