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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!

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

EEG Technologist Skills Checklist

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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*
E-Mail Address* Phone Number*
1. No theory and/or experience
2. Limited experience/need supervision and/or support
3. Experienced/minimal support needed to perform
4. Proficient/can perform independently
Perform the Following:
1 2 3 4
10-20 Electrode Placement
Portable Recording in Adult ICU
Portable Recording in Pediatric ICU
Portable Recording in NICU
ECI-Brain Death Recording
Ambulatory EEG
Sleep Deprived EEG
Sleep EEG
Evoked Potentials
1 2 3 4
Somatosensory Evoked Potentials (SSEP)
Motor Evoked Potential (OR)
Visual Evoked Potential
Auditory Evoked Potential
Assist with Nerve Conduction Studies/Electromyography
1 2 3 4
Nihon Koden
1 2 3 4
Obtain Patient History
Changes in Patient Status
Post Hyperventilation
Interpreting EEG Patterns
1 2 3 4
National Patient Safety Goals
Computerized Charting
My experience is in the following settings:
Yrs. Adult Inpatient
Yrs. Adult Outpatient
Yrs. Pediatric Inpatient
Yrs. Pediatric Outpatient
Yrs. Neonatal
Yrs. Management
Yrs. Rehabilitation
Yrs. Intraoperative Monitoring Experience
EEG Credential (ABRET)
Registered EEG Tech
Small calendar
Exp. Date 
EEG Technologist Skills Checklist, version 4

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.

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