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Job Application
Hiring Interview
Services
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Resource
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SHOP

Hiring Interview Appointment

Personal information

Name *

First

Last

Email *

Phone

No experience: requires education, training and supervision
Intermittent experience: may need support or supervise
Proficient: consistent experience, independent
Expert level: can teach/supervise others.

Work settings

Acute care setting

1
2
3
4

Ambulatory setting

1
2
3
4

Clinic

1
2
3
4

Hospice

1
2
3
4

Physician offices

1
2
3
4

Assessment

12 Lead EKG

1
2
3
4

Height/Weight

1
2
3
4

Interpretation of Laboratory results

1
2
3
4

Medication Reconciliation

1
2
3
4

Patient health history report

1
2
3
4

Vital signs

1
2
3
4

IV Therapy

IV starts

1
2
3
4

Port management/access

1
2
3
4

Routes of administration

1
2
3
4

Principles of administration

1
2
3
4

Nerve Blocks

Brachial plexus block

1
2
3
4

Celiac plexus block

1
2
3
4

Cervical epidural

1
2
3
4

Cervical paravertebral block

1
2
3
4

Diagnostic nerve block

1
2
3
4

Elbow block

1
2
3
4

Epidural steroid injection

1
2
3
4

Facet joint injection

1
2
3
4

Lumbar epidural block

1
2
3
4

Lumbar Sympathetic Block

1
2
3
4

Maxillary nerve block

1
2
3
4

Ophthalmic nerve blocks

1
2
3
4

Sphenopalatine nerve block

1
2
3
4

Stellate ganglion block

1
2
3
4

Subarachnoid block

1
2
3
4

Supraorbital nerve blocks

1
2
3
4

Sympathetic nerve block

1
2
3
4

Thoracic epidural

1
2
3
4

Trigeminal nerve blocks

1
2
3
4

Wrist block

1
2
3
4

Pain scales

Brief Pain Inventory (BPI)

1
2
3
4

FLACC

1
2
3
4

Non-Verbal

1
2
3
4

N-PASS

1
2
3
4

Numerical rating scales

1
2
3
4

Visual Analogue Scale (VAS)

1
2
3
4

Wong-Baker Faces

1
2
3
4

Pharmacological

Adjuvant therapy

1
2
3
4

Anti-convulsants

1
2
3
4

Anti-depressants

1
2
3
4

Anti-spasmodics

1
2
3
4

Epidural analgesia

1
2
3
4

Intrathecal analgesia

1
2
3
4

Local Anesthetics

1
2
3
4

Non-opioids

1
2
3
4

Nurse controlled analgesia (NCA)

1
2
3
4

Opioids

1
2
3
4

Patient-controlled analgesia (PCA)

1
2
3
4

Radiotherapy

1
2
3
4

Subcutaneous/Intravenous infusion analgesia

1
2
3
4

Professional knowledge/skills

Adjuvant Safety

1
2
3
4

Analgesic ladder

1
2
3
4

Aseptic technique

1
2
3
4

Biohazard waste disposal

1
2
3
4

Breathing Techniques

1
2
3
4

Complications of regional anesthesia (motor/sensory block, hemodynamic instability)

1
2
3
4

Counseling

1
2
3
4

Equianalgesic chart

1
2
3
4

Fall prevention

1
2
3
4

Medication misuse/diversion

1
2
3
4

Non verbal/non cognitive signs of pain

1
2
3
4

Opioid Safety

1
2
3
4

Pain descriptors and characteristics

1
2
3
4

Pain process

1
2
3
4

Pain Tolerance

1
2
3
4

Physical dependence

1
2
3
4

Prevention strategies to minimize side effects

1
2
3
4

Safety and injury protection

1
2
3
4

Side effect management

1
2
3
4

Signs and symptoms of toxicity

1
2
3
4

Transcutaneous Electrical Nerve Stimulation (TENS)

1
2
3
4

Special populations

Confused adult

1
2
3
4

Infants/children

1
2
3
4

Non-communicative patient

1
2
3
4

Older adult

1
2
3
4

Suspected substance abusers

1
2
3
4

Types of pain

Acute pain

1
2
3
4

Breakthrough pain

1
2
3
4

Chronic pain

1
2
3
4

Hyperalgesia

1
2
3
4

Neuropathic pain

1
2
3
4

Visceral pain

1
2
3
4

COMPUTERIZED CHARTING

Allscripts

1
2
3
4

Cerner

1
2
3
4

EPIC

1
2
3
4

McKesson

1
2
3
4

Meditech

1
2
3
4

Other:

1
2
3
4

If other, please specify

Age specific competency

Neonate

1
2
3
4

Infant

1
2
3
4

Child

1
2
3
4

Adolescent

1
2
3
4

Young Adult

1
2
3
4

Middle Adult

1
2
3
4

Older Adult

1
2
3
4

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