WTCP Healthcare Interview Profile Template

WTCP Healthcare Interview Profile Template
Recruiter Name

First NameLast Name
Date

MonthDayYear
Date
Candidate Name

First NameLast Name
Candidate's Phone
Please enter a valid phone number.Format: (000) 000-0000.
Candidate's Email
example@example.com
Current Specialty?
How Many Years?
Your Preferred Specialty?
Do You Have Experience In It?

Ideal Setting?

Rows	Yes	No
Days
Nights
Mids
Flexible

Preferred Shift
Weekends Ok?
On Call Ok?
Do You Float? What Units?
Highest Acuity Hospital Worked?
Travel Contract Experience?
Willing to Travel
If So Where?
Radius?
States Licensed In?
Compact?
Desired States To Work In?
Computer Charting System Used?
BLS
Expiration Date

MonthDayYear
Date
ACLS
Expiration Date

MonthDayYear
Date
PALS
Expiration Date

MonthDayYear
Date
Other Certifications?
Experience Providing Care to Children (If Applicable)
Medical Documentation
TB Last Taken?

MonthDayYear
Date
TB How Taken?
Access To Immunization Records?
Titers Status?
Physical Last Taken?

MonthDayYear
Date
Covid Status?
Updated Resume With Last 7 Years Experience or From Graduation?
Already Scheduled Days Off?
US Citizen?
If No, Do You Have A Green Card?
Housing Required?
Traveling With Pets ; Dog, Cat, Other?
Minimum Take Home Pay After Taxes?
Ideal Start Date?

MonthDayYear
Date
Need to Give Notice to Employer? What if They Counter Offer?
Submittal Information Needed
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN (needed for submittal)
Can't Work For (PRN, FIRED, DISLIKES):
Won't Accept?
Have You Worked For Or Been Submitted To This Client Previously?
Currently Working With Any Other Agencies?
Currently Submitted To Any Other Contract Positions?
Professional Reference 1
Name, title, phone, and or email
Professional Reference 2
Name, title, phone, and or email
Can We Contact These References (We Will Need These For Submittals
Notes:
Repeat everything you just talked about regarding the job search and get commitments from the candidate. "if i find you...then will you accept?"
Should be Empty:

WTCP Healthcare Interview Profile Template

Medical Documentation

Submittal Information Needed