Last Name | |
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First Name |
1 Do you possess a Bachelor's degree in Nursing or a closely related field? Please ensure that the information is clearly identified in the Education section of the employment application. |
Yes No |
2 In order to be eligible for the Staff Nurse IV in the Emergency Department, the following classes, courses, or certifications must have been successfully completed. Please check all that apply: Note: Please submit copies of all certifications with the completed employment application, or send via email to kparker@sjgov.org, or fax to (209) 468-0508. |
ACLS |
ED Essentials or equivalent |
MICN-Code 3 clearance |
MSE Triage |
PALS |
Preceptor class or equivalent |
CEN or CCRN |
TNCC or ENPC |
None of the above |
3 Please identify the number of years of full-time (40 hours per week) paid RN experience in an acute care hospital's ER department you possess. |
Less than 1 year of RN experience in an acute care hospital's ER |
1-2 years of RN experience in an acute care hospital's ER |
More than 2 years of RN experience in an acute care hospital's ER |
I do not possess any RN experience in an acute care hospital's ER |
4 Please provide your RN license number below: |
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