Professional Documents
Culture Documents
Date: Name:
Phone: Location:
*Email: Available Start Date:
Unit: Manager:
1. Travelers full legal name (as it appears on their RN license) AND middle initial:
2. Are you fully vaccinated with the COVID Vaccine? If not, are you willing to get it?
5. When could you start an assignment at URMC? Would there be any issue with your starting on-time?
6. When can the HCP interview for the position at URMC (please provide SPECIFIC dates and times the HCP is
available)?:
7. Are you requesting any time off? If Yes, what are the dates?
8. Is the candidate aware AND accepting the 12 hours, D/E/N ROTATING SHIFT SCHEDULES, Every Other
Weekend (EOW), Holidays/On-Call/Callback/Charge per Unit Needs schedules?
11. Do you have at least 2 years of experience in the area that you are applying for?
13. What Current Certifications do you hold? Are the certifications obtained from the AHA?
16. Have you ever worked at any of the University of Rochester System locations as a traveler or as an employee?
17. Are you eligible to return?
Select all that apply
_____ Strong Memorial Hospital
_____ Highland Hospital
_____ Highlands at Brighton
_____ St James Hospital
_____ Noyes
_____ MCH
_____Jones Memorial Hospital
_____ FF Thompson Hospital
19. Are you currently working another job or travel assignment? If not, how many years has it been since you
worked a travel assignment?
22. Have you ever been terminated from an assignment (attitude or attendance)? If so, why?
23. Upon completion of your assignment here – would you consider a full-time placement with the hospital or are
you just looking at travel assignments right now?
Interviewer Contact:
Comments:
Interview Time for the next 2 days (please provide SPECIFIC dates and times the HCP is available):