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Job Application
Hiring Interview
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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

Hospital

1
2
3
4

Clinic

1
2
3
4

Home Health/Hospice

1
2
3
4

LTAC/SNF

1
2
3
4

Colostomy/Ileostomy

Colostomy care and management

1
2
3
4

Continence skin care management

1
2
3
4

Double barrel stoma

1
2
3
4

End stoma

1
2
3
4

Ileal lavage

1
2
3
4

Ileostomy care and management

1
2
3
4

Irrigation

1
2
3
4

Loop with Rod stoma

1
2
3
4

Mucous fistula

1
2
3
4

Ostomy equipment selection

1
2
3
4

Continence Evaluation

Biofeedback

1
2
3
4

Cystometrogram

1
2
3
4

Electomyography

1
2
3
4

Leak point pressures

1
2
3
4

Manometry

1
2
3
4

Pudendal Nerve Terminal Motor Latency

1
2
3
4

Urodynamics

1
2
3
4

Uroflometry

1
2
3
4

Continence Therapeutic Devices

Catheters- Management and self care teaching

1
2
3
4

Fecal incontinence program

1
2
3
4

Internal urethral inserts

1
2
3
4

Magnetic therapy

1
2
3
4

Male external catheters

1
2
3
4

Penile Clamps

1
2
3
4

Urinary incontinence program

1
2
3
4

Vaginal Cones

1
2
3
4

Ileal Pouches

Kock Pouch

1
2
3
4

J Pouch

1
2
3
4

Identification/management of risk factors impacting skin integrity

Burns 1st, 2nd, 3rd, 4th degree

1
2
3
4

Hypoalbuminemia

1
2
3
4

Nutritional status

1
2
3
4

Pressure ulcer

1
2
3
4

Venous ulcer

1
2
3
4

Necrotic debris

1
2
3
4

Melanoma

1
2
3
4

Cellulitis

1
2
3
4

Edema

1
2
3
4

Symptom management

Alteration in skin and mucous membranes

1
2
3
4

Altered mental status

1
2
3
4

Constipation/diarrhea

1
2
3
4

Fatigue/lethargy/weakness

1
2
3
4

Pain management

1
2
3
4

Stomatitis

1
2
3
4

Ulcer Risk Assessment tools

Braden scale assessment

1
2
3
4

Prevention Risk Assessment tools Adult

1
2
3
4

Prevention Risk Assessment tools Pediatrics

1
2
3
4

Wound/Ulcer Assessment & Management

Neuropathic ulcer assessment

1
2
3
4

Neuropathic ulcer management

1
2
3
4

Peripheral arterial ulcer assessment

1
2
3
4

Peripheral arterial ulcer management

1
2
3
4

Pressure ulcer staging

Stage I

1
2
3
4

Stage II

1
2
3
4

Stage III

1
2
3
4

Stage IV

1
2
3
4

Tunneling

1
2
3
4

Undermining

1
2
3
4

Venous status ulcer assessment

1
2
3
4

Venous status ulcer management

1
2
3
4

Wound Treatments/Dressings

Alginates

1
2
3
4

Autolytic debriding agents

1
2
3
4

Electrical Stimulation

1
2
3
4

Enzymatic Debriding Agents

1
2
3
4

Foams

1
2
3
4

Growth factors

1
2
3
4

Hydrocolloids

1
2
3
4

Hydrogels

1
2
3
4

Hyperbaric Oxygen Therapy

1
2
3
4

Mechanical debridement

1
2
3
4

Mist Therapy

1
2
3
4

Petroleum

1
2
3
4

Sharp debridement

1
2
3
4

Silver Products

1
2
3
4

Skin Substitutes

1
2
3
4

Vacuum Assisted Closure

1
2
3
4

Wet to damp dressing change

1
2
3
4

Wound Cultures

1
2
3
4

Wound Vac Therapy

1
2
3
4

Professional Knowledge and Skills

G-tube/J-tube feeding and site care

1
2
3
4

Infection control

1
2
3
4

Interpretation and communication of lab values

1
2
3
4

Isolation precautions

1
2
3
4

National Patient Safety Goals/Core Measures

1
2
3
4

Patient/family teaching

1
2
3
4

Staff education

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

Other:

1
2
3
4

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

If other, please specify

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