Wellpath Warrior Online Application The purpose of this application is to learn more about you as it pertains to joining the Wellpath Warriors. You may be onsite short-term to provide cross-training, implementation of workflow processes, coverage of shifts and/or shadowing new Wellpath employees.Name* Date Submitted* MM slash DD slash YYYY Your Preferred Telephone Number*Your Email Address* Current Work Site/Location* Did your supervisor/HSA approve you to assist with transitions?* Yes No Who is your supervisor?* Supervisor's Telephone Number*What is your current position with Wellpath?* What shift do you currently work?* Days Evenings Nights Weekends Are you currently full-time, part-time or per diem?* Full Time Part Time Per Diem Licensure* RN LPN LVN MD AA HSA DON Other State of Licensure* Nursing Licensure Compact state?* Yes No If yes, which state?* Do you have any certifications?* Yes No If yes, what certifications do you hold?* When does your BCLS/ACLS expire?* (NOTE: It is a possibility you will be assigned a different shift during the transition. For example, you may be assigned to work 7:00pm – 7:00am).Have you participated in previous transitions?* Yes No If yes, when and where?*Do you have experience with training, onboarding and/or being a preceptor?* Yes No If yes, please describe your experience.What areas have you worked within your facility? Check all that apply.* Intake Medication Nurse Health Assessments Nurse Charge Nurse Sick Call Nurse History & Physical Nurse Infirmary/Observation Nurse Detox Nurse Mental Health Nursing Documentation Pathways Infectious Disease Chronic Care Dental Clinic Other Other What is your area of expertise?* Which of the following systems do you feel most comfortable teaching someone for patient documentation? Check all that apply.* ERMA CorEMR POCC Paper Documentation SAPPHIRE Other Other Do you have experience with completing CQI Studies?* Yes No Do you feel comfortable providing training (classroom setting) in the following areas?* Yes No If yes, please check all that apply.* Emergency Response/NARCAN Detox (CIWA/COWS) Clinical Skills Lab Health Assessments 7 Minutes to Save Nursing Documentation Protocols Medication Administration Controlled Substance Other Other How would your colleagues describe your temperament?*In a brief summary, why should you be selected for the Wellpath Warriors?*Please provide any additional information about you that was not included above.Date* MM slash DD slash YYYY CAPTCHAThe minimum requirements to become a Wellpath Warrior: Six months experience in corrections A clear background check Valid driver’s license Willing to travel Able to commit to a minimum of 2-3 transitions per year Pass all Warrior policy/procedure exams EHR and computer skills Good standing at current site/no disciplinary action Professionalism (attire and attitude) Shift flexibility (including 12+ hour shifts and possible night shifts) Please allow 5-7 business days to review and process.
