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Long Term Care Skills Checklist

Fill Out and Submit your Skills Checklist

I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Skills Checklist

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1No Experience

2Need Training

3Able to perform with supervisione

4Able to perform independently

CARDIAC

GENITOURINARY

ENDOCRINE

GASTROINTESTINAL

LEADERSHIP/PATIENT CARE

MEDICATIONS/IV THERAPY

NEUROLOGY

ORTHO/SKIN

RESPIRATORY

Age Specific Competencies

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contact@selectsourceintl.com
care@selectsourceintl.com
Phone: +1-952-546-3300
Fax: +1-952-546-3500
13911 Ridgedale Drive, Suite 230
Minnetonka, Minnesota 55305, United States

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