Skills Checklist

  • Skills Checklist

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  • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

    1: Familiar with the procedure, but will usually or almost always require some assistance.

    2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

    3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

    NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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  • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

  • Clear
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    • OT/COTA 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • PT/PTA 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Social Worker 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Surgical Technologist 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Certified Nursing Assistant  

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Medical Tech/Certified Medical Tech/Phlebotomist 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Respiratory Therapist 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Home Health Registered Nurse 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Theory Only/No Experience – Didactic instruction only, no hands on experience

      2: Limited Experience – Knows procedure/has used equipment, but has done so infrequently or not within the last six months

      3: Moderate Experience – Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed

      4: Proficient/Competent – Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • STERILE PROCESSING TECHNOLOGIST 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Long Term Care Licensed Practical Nurse 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Theory Only/No Experience – Didactic instruction only, no hands on experience

      2: Limited Experience – Knows procedure/has used equipment, but has done so infrequently or not within the last six months

      3: Moderate Experience – Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed

      4: Proficient/Competent – Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • BCBA 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Long Term Care Registered Nurse 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Theory Only/No Experience – Didactic instruction only, no hands on experience

      2: Limited Experience – Knows procedure/has used equipment, but has done so infrequently or not within the last six months

      3: Moderate Experience – Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed

      4: Proficient/Competent – Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Medical Assistant 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • OR Nurse 

    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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    • Psych Nurse 
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    • Please provide accurate answers so we can correctly match your abilities to our client job requirements. Check the level of experience and expertise you have in each skill category using the following scale:

      1: Familiar with the procedure, but will usually or almost always require some assistance.

      2: Competent and familiar with the procedure: I can perform this procedure with excellence, usually without assistance.

      3: Very competent: I have at least 12 months experience and can perform this procedure with excellence and without assistance.

      NOTE: Choose 0 for any procedures which you have no experience, training, or low competence.

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    • By signing my name in the space provided below, I attest that I have completed the above form accurately and truthfully and have in no way misrepresented my skills or abilities.

    • Clear
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