Online Interview

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First Name






Last Name






Address







City





State





ZIP Code





Phone





Email





Employment History

Current Employer:
Current Position:
Previous Employer:
Previous Position:


Education:




Do you have a valid state license in Radiation Therapy?
Yes
No




Do you have a current ARRT Registration in Radiologic Technology or Radiation Therapy?
Yes
No




How many years of education have you completed?
Some college coursework
Two-year college degree
Four-year college degree
Beyond a four-year college degree


Experience:




How many years experience do you have in the position for which you are interested?
No experience
Less than one year
At least 1 to 3 years
At least 4 to 6 years
At least 7 to 9 years
Ten or more years




What type of setting best describes your work experience?
Hospital
Outpatient Clinic
Academia/Research
Other




Do you have experience educating patients regarding treatment side effects?
Yes
No




Do you have experience working with children?
Yes
No




Do you have experience constructing and fitting immobilization and accessory devices to shape, modify and block radiation?
Yes
No




Do you have experience calculating the radiation dose for a patient?
Yes
No




Do you have experience performing repairs to radiation therapy equipment?
Yes
No




Have you worked with aides or other medical support staff?
Yes
No


Work/Salary:




Would you be interested in temporary assignments or on-call work?
Yes
No




Are you able to work evenings?
Yes
No




Are you able to work weekends and holidays?
Yes
No




Please indicate what annual base rate you are looking to receive:
Up to $40,000 per year
Up to $50,000 per year
Up to $60,000 per year
$60,000 or more per year


General:




Are you interested in working full time or part time?
Full time
Part time




Are you currently employed?
Yes
No




How many miles from your home are you willing to travel to work?
Up to 5 miles
Up to 10 miles
Up to 20 miles
Over 20 miles




Would you relocate to another state?
Yes
No




Are you at least 18 years of age and eligible to work in the United States?
Yes
No




Are you bi-lingual or multi-lingual?
Yes
No




In addition to English, in which language are you most fluent?
Spanish
French
Italian
German
Russian
Chinese
Japanese
Other
None




Would you consent to pre-commencement testing, if required, including drug screening, medical testing and/or skill-related testing?
Yes
No




Would you consent to pre-employment background checks, if required, including past employment information, education verification, and/or reference checks?
Yes
No




Are you now or have you been a member of the United States Military, National Guard or Reserves?
No
I am a Veteran of the United States military
I am currently a member of the United States military
I am currently a member of the National Guard or Reserves
I was a member of the National Guard or Reserves



Please take a moment to briefly share any additional information about yourself that you feel a prospective employer would like to know. We do not recommend pasting of resumes or cover letters.


Additional Info:
 

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