Online Interview

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Employment History

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

Education:

Do you have a Certified Respiratory Therapist license? Yes No

Do you have a Registered Respiratory Therapist license? Yes No

How many years of education have you completed? Technical Degree Two-year college degree Some college classes Four-year college degree Beyond four-year college degree Master's 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 Private Practice Long-Term/Residential Care Facility Home Healthcare Other

If applicable, what type of area describes your specialty? Respiratory Anesthesiology Pulmonary Critical Care Pediatric Other

Do you have experience assisting physicians with high risk birth? Yes No

Do you have experience working with children? Yes No

Do you have experience assisting anesthesiologists in the operating room and administering appropriate medical gases and medications? Yes No

Do you have experience working with senior citizens? Yes No

Do you have experience working with insurance companies and third party payers? Yes No

Do you have experience educating patients on their respiratory conditions and teaching appropriate disease management techniques? Yes No

Do you have experience in maintaining and calibrating respiratory therapy equipment? Yes No

Do you have experience with using software to help manage patient care? Yes No

Work/Salary:

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

What is your shift preference? Days Afternoons Evenings Midnights Any shift

Are you able to work weekends and holidays? Yes No

Are you available to rotate your schedule? Yes No

Please indicate what annual base rate you are looking to receive: Up to $30,000 per year Up to $35,000 per year Up to $40,000 per year Up to $45,000 per year Up to $50,000 per year Up to $55,000 per year $55,000 or more per year

General:

If the position requires traveling, do you have a valid driver's license and proof of automobile insurance? Yes No

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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