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Skills Checklists

Congratulations on your decision to apply for an allied position with ClubStaffing! Before we can offer you an allied employment opportunity, an electronic skills assessment must be completed. From the skills checklist below, please locate the list that matches your specialty and complete the online form. Be sure to review your information thoroughly before clicking the submit button. Thank you!

ClubStaffing
5901 Broken Sound Pkwy.
Suite 450
Boca Raton, Florida 33487
Fax: (561) 367-0884


Medical Laboratory Technician/Medical Technologist/Phlebotomist Skills Checklist

*
Denotes required field

This profile is for use by healthcare professionals in this discipline and specialty.  It will not be a determining factor for the program.
Please enter your full legal name as it appears on your Social Security Card.
First Name* Middle Name Last Name*
Last 4 of Social Security Number*
- -
E-Mail Address* Phone Number*
or
 
1. No experience; requires education, training and supervision 2. Intermittent experience; may need support or supervision
3. Proficient; consistent experience, independent 4. Expert level; can teach/supervise others
 
WORK SETTINGS
1 2 3 4
 
Acute Setting
 
Free Standing Lab
 
Reference Lab
 
BLOOD BANK
1 2 3 4
 
ABO/Rh/Antibody Screen & ID
 
Antibody Typing: Gel Method
 
Antibody Typing: Tub Method
 
Antigen Typing
 
Cold Agglutinins
 
Cord Blood Evaluation
 
Crossmatch - Immediate Spin/IgG
 
Donor Collection Procedures
 
Emergency Release
 
Issue Blood Product to Pt. Care Area
 
Rhogam Screening
 
Thawing/Cooling of Blood Products
 
Transfusion Reaction Workup
 
Instrumentation (Specify)
 
Instrumentation (Specify)
 
CHEMISTRY
1 2 3 4
 
Acetone Analysis
 
Analyzer Use/Troubleshooting
 
Arterial Blood Gas
 
B -12 Folates
 
Cardiac Enzymes
 
Chromatography - Gas
 
Chromatography - Thin Layer
 
Electropheresis
 
Hormone/Thyroid
 
Immunoassay
 
Osmolality
 
Specimen Preparation
 
Stool Analysis
 
Therapeutic Drug Monitoring
 
Tumor Markers
 
Review & Interpretation of QC
 
Instrumentation (Specify)
 
Instrumentation (Specify)
 
HEMATOLOGY/COAGULATION
1 2 3 4
 
Automated Instrument Use
 
Body Fluid Analysis
 
CBC Manual
 
D-Dimer
 
Differential Manual
 
Factor Assays
 
Fetal Hemoglobin
 
Fibrin Degradation Products
 
Fibrinogen
 
Platelet Count
 
Platelet Morphology
 
PT/PTT/INR
 
RBC Morphology
 
Reticulocyte Count
 
Sed Rate Manual
 
Special Stains - e.g. PAS, LAP, Peroxidase
 
Thrombin Time
 
Platelet Function Analysis
 
Instrumentation (Specify)
 
Instrumentation (Specify)
 
IMMUNOLOGY/SEROLOGY
1 2 3 4
 
ANA
 
CMV
 
HIV Antibody Detection
 
HIV Rapid
 
LE Prep
 
Rheumatoid Titer
 
RPR/RPR Titer
 
Rubella
 
Instrumentation (Specify)
 
Instrumentation (Specify)
 
MICROBIOLOGY
1 2 3 4
 
AFB Stain/Culture
 
Chlamydia
 
Cultures
 
Kit Testing - Monospot/ASO Titer
 
Kit Testing - Flu/Rapid Strep/RSV
 
O&P
 
Processing Specimens for Viral/Fungal Cultures
 
Sensitivities
 
Sub Cultures
 
Vitek
 
Wet Prep/KOH Prep
 
Instrumentation (Specify)
 
Instrumentation (Specify)
 
URINALYSIS
1 2 3 4
 
Crystal Identification
 
Macroscopic Analysis
 
Microscopic Analysis
 
Pregnancy Testing
 
Instrumentation (Specify)
 
Instrumentation (Specify)
 
PHLEBOTOMY
1 2 3 4
 
Adult Venipuncture
 
Arterial Draw
 
Bleeding Time
 
Blood Alcohol Collection
 
Blood Culture Collection
 
Butterfly Draw
 
Centrifuge Operation
 
Dermal Stick (Finger/Heel)
 
Drug Screening Collection
 
Pediatric Venipuncture
 
PPE Equipment (Gloves/Mask, etc.)
 
Tube Types and Usage
 
GENERAL EQUIPMENT
1 2 3 4
 
Beckman
 
Hitachi
 
Ortho Vitros
 
Roche
 
Other: Specify
 
Other: Specify
 
LAB INFORMATION SYSTEMS
1 2 3 4
 
Cerner
 
Horizon
 
Meditech
 
Orchard
 
Sunquest
 
Other: Specify
 
Other: Specify
 
CERTIFICATIONS (Current at time of completing this form)
 
ASCP - MLS or MT
 
ASCP - MLT
 
ASCP - HT/HTL
 
ASCP - BB
 
ASCP - C
 
ASCP - CG
 
ASCP - CT
 
ASCP - H
 
ASCP - M
 
ASCP - MB
 
Cert. Phlebotomy Technician (CBT-ASCP)
 
Other: Specify
Medical Laboratory Technician/Medical Technologist/Phlebotomist Skills Checklist, version 7

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. Falsification of any information provided, will result in being ineligible to travel with AMN. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

© 2018 AMN Healthcare, Inc. All rights reserved. Reproduction and distribution of these materials is prohibited without the expressed written authorization of AMN Healthcare, Inc.