Director of Rehab

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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
LEADERSHIP/MANAGEMENT

0 1 2 3 4 5

0 1 2 3 4 5

Proficiency Rating Frequency Rating
Team Leadership*
Conflict Resolution*
Staff Development*
Performance Evaluation*
Change Management*

CLINICAL KNOWLEDGE

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Rehabilitation Techniques*
Evidence-Based Practice*
Patient Assessment Skills*
Treatment Planning*
Outcome Measurement*

COMMUNICATION SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Interdisciplinary Collaboration*
Patient and Family Communication*
Public Speaking and Presentation*
Written Communication*
Cultural Competence*

ADMINISTRATIVE SKILLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Budget Management*
Regulatory Compliance*
Policy Development*
Data Management and Reporting*
Resource Allocation*

PERSONAL DEVELOPMENT

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Adaptability to Change*
Stress Management*
Networking/Professional Development*
Time Management*
Self Reflection and Improvement*

SETTING

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Acute*
Rehab*
Inpatient*
Outpatient*
Home Health*
SNF*
Schools*

ADULT

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Orthopedic:

Fractures*
Total Joint Replacemnt*
Osteoarthritis-Frozen Shoulder*
Hand Injuries*
Post Operative Care*
Amputations*

Neurologic:

Stroke Rehabilitation*
Cognitive Disorders*
Head Trauma*
Spinal Cord Injury*
Neuromuscular Diseases*
Alzheimers Diseases*
Adaptive Equipment-Wheelchair*

Prosthetics / Orthotics:

Upper Extremity Prosthetics*

Procedures / Treatments:

Splinting-Wrist*
Splinting-Hand*
Splinting-Elbow*
Functional-Dynamic Splinting*
Adaptive Equipment*
Joint Mobilization*
Myofacial Release*
Soft Tissue Manipulation*
Iontophoresis*
TENS*
Hydrotherapy-Whirlpool*
Sterilization Techniques*
Cryotherapy*
Wound Management*
Debridement*
Ultrasound*
Phonophoresis*
Cognitive Techniques*
Vision Therapy*
Neurodevelopment Techniques*
Adaptive Equipment Assessment*
Adaptive Equipment Training*
Feeding Techniques*
Exercise Programs*
Postural Education*
Home Safety Evaluation*
Community Re-entry*
Group Treatment*

GERIATRIC

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Skilled Nursing Documentation:

Medicare A*
Medicare B*
State Healthcare*

Other:

Cardiac Rehab*
ICU Procedures*
CCU Procedures*
SICU Procedures*
Burn Management*
Work Hardening - Work Site Eval*
Functional Capacity Eval*
Transfers*
Gait Training*
Muscle Energy Techniques*
Activities of Daily Living*
Electronic Documentation*
List Types:
Electronic Documentation*
List Types:
Electronic Documentation*
List Types:

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)*
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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