OnLine Candidate Profile Sheet
Answer all questions completely. Forms are evaluated on completeness and accuracy.
General Information
Name:
Current Area of Practice:

Current Employment
	Hospital Name:
	Schedule	Full Time Part Time
	Bed Capacity of the Hospital:
	Bed Capacity of the Unit:
	Nurse to Patient Ratio:
Experience
	Years of Experience as Registered Nurse:
	Years of Experience in direct, primary care:
	List the specific types of cases you handle:
	1)     2)     3)     4)     5)
	List your job description and current responsibilities:
	1)     2)     3)     4)
	Do you supervise any staff on your unit?:	Yes No
	If Yes, Explain:
	Is your current assignment in a teaching hospital?:	Yes No
	Largest hospital worked in:	Beds
	Smallest hospital worked in:	Beds
Qualifications
	List the specialized equipment used every day:
1)    5)         2)    6)         3)    7)         4)    8)
	Are you proficient in veni-puncture and IV therapies?:	Yes No
	Are you familiar with EKG tracings?:	Yes No
	List the common dysthrymias you are able to identify:
1)    4)         2)    5)         3)    6)
	List any special certifications you hold, such as BLS, BCLS, Chemo, etc.:
1)    4)         2)    5)         3)    6)
	Computer or keyboard skills:
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