WTCP RN Interview Profile Template
Recruiter Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Candidate Name
First Name
Last Name
Candidate's Phone
Please enter a valid phone number.
Candidate's Email
example@example.com
Current Specialty?
How Many Years?
Your Preferred Specialty?
Do You Have Experience In It?
Ideal Setting?
Yes
No
Days
Nights
Mids
Flexible
Preferred Shift
8 Hours
10 Hours
12 Hours
Weekends Ok?
Yes
No
On Call Ok?
Yes
No
Do You Float? What Units?
Highest Acuity Hospital Worked?
Travel Contract Experience?
Yes
No
Willing to Travel
Yes
No
If So Where?
Radius?
States Licensed In?
Compact?
Yes
No
Desired States To Work In?
Computer Charting System Used?
BLS
Yes
No
Expiration Date
-
Month
-
Day
Year
Date
ACLS
Yes
No
Expiration Date
-
Month
-
Day
Year
Date
PALS
Yes
No
Expiration Date
-
Month
-
Day
Year
Date
Other Certifications?
Experience Providing Care to Children (If Applicable)
Medical Documentation
TB Last Taken?
-
Month
-
Day
Year
Date
TB How Taken?
Access To Immunization Records?
Titers Status?
Physical Last Taken?
-
Month
-
Day
Year
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?
-
Month
-
Day
Year
Date
Need to Give Notice to Employer? What if They Counter Offer?
Submittal Information Needed
Permanent Address
Street Address
Street Address Line 2
City
State / 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?"
Submit
Should be Empty: