PSYCHIATRIC OMPETENCY SELF ASSESSMENT
TREATMENT SETTINGS
PSYCHIATRIC
Assessment
Communication techniques
Equipment/procedures
Care of patient with
Medications
EXPERIENCE WITH AGE GROUPS
MY EXPERIENCE IS PRIMARILY IN: (Please indicate number of years)
All the information on this page is true and accurate to the best of my knowledge. By completing this form, I am authorizing Professional Staffing to release this information to the appropriate client facilities in consideration of employment as a registry, local traveler of full traveler.
This form has been Electronically Signed and Authenticated by:
Date:
Please Enter Your Name and Date and then click the Submit Button