Last Name | |
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First Name |
1 Licenses & Certifications Do you possess a current active license as a registered nurse from the California Board of Registered Nurses (CA BRN)? |
Yes No |
1a Please provide your RN license number which will be source verified. A copy of your RN license must be submitted with your completed employment application. Please attach to your application when prompted for a resume, send to msneed@sjgh.org, or fax to 209-468-6271. |
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2 The following courses/certifications are all required for the position of Staff Nurse V-ADM Inpatient for the Emergency Department. (NOTE: Copies of certifications and course completions must be submitted with your employment application in order to be considered). Please check all that apply: |
I have completed an ED Essentials course or equivalent. |
I have completed an MSE Triage course. |
I have completed a Preceptor course or equivalent. |
I have completed a PALS course. |
I possess MICN-Code 3 clearance. |
I possess current ACLS certification. |
I do not possess any of the certifications noted above. |
3 Please indicate the education completed and/or the national certification you possess below. Check all that apply. |
Bachelor's degree in Nursing or related field. |
CEN (Certified Emergency Nurse) |
CCRN (Critical Care RN) |
TNCC (Trauma Nursing Core Curriculum) |
ENPC (Emergency Nurse Pediatric Course) |
None of the above |
4 Please indicate the total number of full-time (40 hours per week) paid RN experience you possess in an acute care hospital ER. |
less than 1 year |
more than 1 year but less than 3 years |
more than 3 years but less than 5 years |
I do not possess any full-time paid RN experience in an acute care hospital ER. |
5 Please provide a detailed description of the specific duties performed as a RN in an acute care hospital ER. |
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6 Please describe your experience as a charge nurse or nursing supervisor. Include in your response the number of staff supervised and how you monitored their performance. |
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