Body Munson Healthcare COVID-19 Workforce Webform I am submitting my information to be on file to assist with the COVID-19 pandemic in either a clinical or non-clinical role. This will ensure that Munson Healthcare will be able to meet evolving staffing requirements to serve the needs of the community and our patients appropriately. While the organization is well-equipped to meet today’s needs, this is a rapidly changing situation. Munson Healthcare appreciates your interest is being available to assist and will contact you if your assistance is needed. Please check “Yes or No” for the questions below. If you answer yes to any of the following, you are unable to assist at this time—please do not complete the form any further. Have you had contact with a confirmed COVID-19 individual? Yes No Have you had a temperature over 100 degrees in the last 2 weeks? Yes No Have you experienced any respiratory symptoms (coughing, shortness of breath, sore throat) in the last 2 weeks? Yes No Please proceed if you selected “No” to all of the above questions. Your Information Full name Email Cell phone number Alternate phone number Highest level of education obtained High school diploma or GED Associate’s degree Bachelor’s degree Master's degree Other For Non-Clinical Positions: If non-clinical, please provide information related to your experience and areas of interest: If you have healthcare experience, please explain in what area: (i.e. Nursing, Patient Care, EVS/Housekeeping, Administrative) For Clinical Positions: If clinical, please complete the following: Current licensure (please list) Current certifications/registrations (please list) Years of healthcare experience What is your specialty (i.e. OR, critical care, medical-surgical, cardiac, etc.) What electronic healthcare record systems do you have experience with? Additional Information What other information do you want Munson Healthcare to know about your interest? This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.