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Data & Privacy Affirmation

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Work Authorization


Do You Require Visa Sponsorship?


Voluntary Self Identification
We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.


































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In the morning (AM)
in the afternoon (PM)
In the evening (PM)
Weekends?

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ER & Trauma
     Emergency Dept. (ED)
         Cardiac
             CathLab
         Minor Care (Fast-Track)
         Observation
         Respiratory
         Resuscitation
         Triage
     Trauma
         Blunt
         Burns
         Head
         Multiple/Complex
         Penetrating
         Spinal
Inpatient Care Units
     Med-Surge
     Step-Down/PCU
     Telemtry
Intensive Care Units (ICU)
     Cardiac (CICU)
         Cath Lab
     Neonatal (NICU)
     Neurosurge (Neuro-ICU)
     Pediatric (PICU)
     Surgical (SICU)
     Trauma (TICU)
Maternal Unit
     Labor & Delivery (L&D)
     Neonatal Nursery
     OBGYN
     Postpartum Unit
Outpatient/Ambulatory
     Ambulatory Care
     Dialysis
     Infusion Therpay
     Outpatient Surgery
Speciality Care Units
     Burn
     Cardiac
     Neurology
     Oncology
     Orthopedic
     Pediatric
     Psychiatric
Surgical/Perioperative
     Intraoperative Unit
     Operating Room (OR)
     Post-Anesthesia (PACU)
     Preoperative Unit

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Doesn't own or rent
Break Lease
Sell House

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Pay
Location
Work life Balance


GED/High School
     Associate's of Nursing (ASN)
     Associates of Arts
         Bachelor's of Engineering
         Bachelor's of Laws
         Bachelor's of Nursing (BSN)
         Bachelor's of Nursing (BSN)
         Bachelors of Art
         Bachelors of Science
             (JD) Juris Doctorate of Law
                 LLM (Master's of Law)
             (MBS) Master's of Biomedical Science
                 (MD) Doctor's of Medicine
                 (OD/DO) Doctor's of Osteopathic Medicine
             MMed Master's of Medicne
             MSN Master's of Nursing
                 DNP Doctor's of Nursing Practine
             Master's of Applied Science
             Master's of Arts
             Master's of Business Administration
             Master's of Laws (LLM)
                 Advanced Tech
                 Business Law
                 Cybersecurity & Privacy Law
                 Employment & Labor Law
                 Entertainment, Arts, & Sports Law
                 Environmental Law & Policy
                 Federal Procurement
                 General
                 Health Law
                 Human Rights Law
                 IP Law
                 International Law & Arbitration
                 Maritime Law
                 Real Estate & Property Law
                 Taxation
             Master's of Medicine (General)
     Associates of Science


Days
Afternoon (swing-shift)
Nights
Weekends

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