X-Ray Technologist

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Director of Rehab

OT

COTA

PT

PTA

SLP/SLPA

CNA

Director of Nursing

LPN

MDS Coordinator

Medication Aide

LTC RN

Ambulatory RN

Antepartum Postpartum Nursery

Behavioral Health RN

Case Management

Cath Lab RN

Certified Surgical First Assistant

CVICU RN

CVOR RN

CVOR Surgical Tech

Dialysis RN

Endoscopy RN

Endoscopy Tech

ER RN

High Risk Skills

Home Health RN

Infection Prevention RN

Intensive Care RN

Infusion RN

LDRP RN

LTAC RN

Maternal Fetal/High Risk

Medical Surgical / Telemetry

Neonatal Intensive Care

Nurse Manager

OB Tech

Oncology

OR RN

OR/Surg Tech

PACU

Pediatric Emergency Room

Pediatric Intensive Care

Pediatric RN

Rehab RN

Sterile Processing Technologist

Surgical Tech

Tele, PCU, Stepdown RN

Transplant Coordinator RN

Home Health Case Manager

Home Health Clinical Manager

Home Infusion RN

Home Health LPN

Home Health RN

Hospice LPN

Hospice RN

Cath

CT Tech

Dosimetrist

Echo

High Risk Skills

Histotechnologist

Interventional Skills

Mammography Skills

MRI Technologist

Nuclear Medicine Technologist

OR/Surg Tech

Pharmacist

Pharmacy Technician

Radiologic Technologist

Radiation Therapist

Sterile Processing Tech

Ultrasound Tech

Vascular Ultrasound

Cytotechnologist

Histotechnologist

Medical Laboratory Technologist

Medical Technologist

Pathologist Assistant

Phlebotomy

Cath Lab RN

Cath Lab Technologist

Cath EP

Interventional Skills

Anesthesia Tech

Dietician

EKG Tech

Perfusionist

Polysomnographer / RPSGT

Respiratory Therapist

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Marvel Medical Staffing.
- 0 = Not Applicable
- 1 = No Experience
- 2 = Some Experience
- 3 = Intermittent Experience
- 4 = Experienced
- 5 = Very Experienced
*Required Field
AGE

0 1 2 3 4 5

0 1 2 3 4 5

Proficiency Rating Frequency Rating
Newborn (birth - 30 days)*
Infant (30 days - 1 year)*
Toddler (1 - 3 years)*
Preschooler (3 - 5 years)*
School Age (5 - 12 years)*
Adolescents (12 - 18 years)*
Young Adults (18 - 39 years)*
Middle Adults (39 - 64 years)*
Older Adults (64+ years)*
Elderly Adults (Over 79+ years)*

GENERAL SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Standard Precautions*
Isolation Precautions*
Pediatric Respiratory / Cardiac Arrest*
Adult Respiratory / Cardiac Arrest*

WORK SETTING

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Adult Acute Care*
Adult Outpatient*
Pediatric Acute Care*
Pediatric Outpatient*
Bedside / Portable Procedures*
ER / Trauma*
OR*

CHEST AND THORAX

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Chest Routine*
Chest SP*
Ribs*
Chest Lateral Decubitus*
Sternum*
Upper Airway (Soft - Tissue Neck)*

UPPER EXTREMITY

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Thumb or Finger*
Hand*
Wrist*
Forearm*
Elbow*
Humerus*
Shoulder*
Trauma*
Clavicle*
Scapula*
AC Joints*

LOWER EXTREMITY

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Toes*
Foot*
Ankle*
Knee*
Tibia - Fibula*
Femur*
Trauma*
Patella*
Calcaneus*

HEAD

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Skull*
Paranasal Sinuses*
Facial Bones*
Orbits*
Zygomatic Arches*
Nasal Bones*
Mandible*
TMJ*

SPINE AND PELVIS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Cervical Spine*
Thoracic Spine*
Lumbar Spine*
Sacrum and / or Coccyx*
Cross - Table Lateral Spine*
Pelvis*
Hip*
Cross - Table Lateral Hip*
Scoliosis Series*
Sacroiliac Joints*

ABDOMEN

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Abdomen Supine (KUB)*
Abdomen Upright*
Abdomen Decubitus*

FLUOROSCOPY STUDIES

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Upper GI Series, Single or Double Contrast*
Contrast Enema, Single or Double Contrast*
Small Bowel Series*
Esophagus*
Cystography / Cystourethrography*
ERCP*
Myelography*
Arthrography*
Hysterosalpingography*

MOBILE RADIOGRAPHIC STUDIES

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Chest*
Abdomen*
Orthopedic*

EQUIPMENT

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

GE*
List Types:
Fuji*
List Types:
Siemens*
List Types:
Toshiba*
List Types:
Hitachi*
List Types:
Portables*
List Types:
C-Arm*
List Types:

COMPUTERIZED CHARTING

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

EMR

eClinicalworks*
EPIC*
McKesson*
Care 360*
Allscripts*
Cerner*
GE*
Optum Insight*
NextGen*
Greenway*

PACS

Ambra Health*
Sectra*
Infinitt*
IBM Merge*
McKesson*
Philips*
FujiFilm*
Impax*
Centricity*
Carestream Vue*
Clarity*
eRad PACS*
Syngo*
Application Agreement*
- I certify that the test was filled out to the best of my knowledge.
Signature*
Date*
First Name*
Last Name*
Applicant Email*
Applicant Phone*

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