Application form




12 hour shifts, Days/Nights/Weekends/Holidays

Previous Experience Required

The ED Technician will be required to complete a checklist of skills.  Only after the required skills have been demonstrated proficiently to the unit manager, will the ED Tech be able to perform these duties independently.

Specialized or Technical Education Required

High school diploma, GED, completion of a Nursing Assistant program, or currently enrolled in nursing program.

Manual or Physical Skill Required

Good mental health to work effectively with patients, families, physicians and other personnel.

Physical Effort Required

Must have good physical health, capable of standing on feet for long periods of time, moving and lifting patients.

Strength: Medium; Push: Occasionally; Pull: Occasionally; Carry: Occasionally; Lift: Occasionally; Sit: Occasionally; Stand: Frequently; Walk: Frequently


Personal Information

*All below fields are required.

Referral Information

*All below fields are required.

Placement Information

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High School

*All below fields are required.


Graduate School

Vocational School/ Other

Certifications / Licenses

License 1

License 2

License 3

License 4

Skills & Qualifications

Employment History

Current Employer

Previous Employer 1

Previous Employer 2


*All below fields are required.

Reference 1

Reference 2

Reference 3

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