CNA

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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
SKILL

0 1 2 3 4 5

0 1 2 3 4 5

Proficiency Rating Frequency Rating
Assist with Admission of Patient*
Assist with Ambulation*
Assist with bedpan/urinal/commode*
Backrubs/ Back care*
Basic Medical Asepsis*
Bathing: Complete/Partial/Sitz*
Bed Cradles*
Bed Making- occupied/unoccupied/surgical*
Bed Rails: when/how to use them*
Cast Care*
Charting/Checklist/Graphic Charts*
Compresses: Warm/ Cold*
Coughing/ deep breathing*
CPR*
Crutch Walking: Assist Patient*
Dangling Patient*
Diabetic Testing*
Dietary Restrictions*
Documentation: vital signs, I & O*
Documentation of Patient’s Belongings*
Douches*
Elastic Stockings (AE hose)*
Elimination Check & Record*
Enemas, Rectal Tubes, Harris Flush*
Fall Precautions*
Feed Patient*
Foley Catheter Care & Emptying*
Footboard*
Glucometer*
Hand Hygiene*
Height: Measure & Record*
Intake & Output Measure & Record*
Orthostatic Blood Pressure*
Transfers*
Use of Assistive Devices*
Vital Signs*
Weight: Measure and Record*
Electronic Documentation*
List Types:
Electronic Documentation*
List Types:
Electronic Documentation*
List Types:

SPECIMEN COLLECTION

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Routine Urine*
Clean Catch*
12 & 24- hour Specimen*
Stool*
Culture*
Sputum*
From Foley Catheter*

INFECTION CONTROL PRECAUTIONS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Standard Universal Precautions*
Reverse Isolation*
TB / Airborne Precautions*
MRSA / VRE Precautions*
Nourishment for Patients*
Observing Patients*
Oral Hygiene*
Patient Safety Standards/Precautions*
Perineal Care*
Positioning Patients*
Prosthetic Devices (care of dentures, contact lenses, etc)*
Range of Motion Exercises*
Reporting Changes of Patient Condition*
Reporting/Recording of Patient’s Pain Level*
Restraints*
Skin Care*
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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