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1.877.891.4286
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
Home
About
Professional Licensure
Payroll & Documents
Apply Now
Open Jobs
Contact
SLP – Skills Checklist
This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Precision Nationwide Staffing.
0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced
Setting
Acute
*
0
1
2
3
4
5
Rehab
*
0
1
2
3
4
5
Inpatient
*
0
1
2
3
4
5
Outpatient
*
0
1
2
3
4
5
Home Health
*
0
1
2
3
4
5
SNF
*
0
1
2
3
4
5
Schools
*
0
1
2
3
4
5
Adaptive Equipment
Assessments
*
0
1
2
3
4
5
Augmentative Communication
*
0
1
2
3
4
5
Computer-Based Treatment/Adaptive Microswitches
*
0
1
2
3
4
5
Speech/Language/Hearing Disabilities
Feeding Disorders
*
0
1
2
3
4
5
Cleft Palate
*
0
1
2
3
4
5
Cognitive Rehab
*
0
1
2
3
4
5
Coma Stimulation
*
0
1
2
3
4
5
CVA/Stroke Rehab
*
0
1
2
3
4
5
Dysphagia
*
0
1
2
3
4
5
Fluency/Stuttering
*
0
1
2
3
4
5
Head Injury
*
0
1
2
3
4
5
Hearing Impaired
*
0
1
2
3
4
5
Laryngectomy
*
0
1
2
3
4
5
Neurological
*
0
1
2
3
4
5
Voice
*
0
1
2
3
4
5
Pediatrics
Cerebral Palsy
*
0
1
2
3
4
5
Early Intervention
*
0
1
2
3
4
5
Learning Language Disabilities
*
0
1
2
3
4
5
Mental Retardation
*
0
1
2
3
4
5
NDT for Speech
*
0
1
2
3
4
5
Other Skills
Accent Reduction
0
1
2
3
4
5
Aural Rehabilitation/Speech Reading
0
1
2
3
4
5
Biofeedback - EMG
0
1
2
3
4
5
Cognitive Assessment
0
1
2
3
4
5
Co-Treatment with OT
0
1
2
3
4
5
Co-Treatment with PT
0
1
2
3
4
5
Family Education
0
1
2
3
4
5
Group Activities
0
1
2
3
4
5
In-service Education
0
1
2
3
4
5
Myofunctional Therapies
0
1
2
3
4
5
Prosthetics - Cleft Palate
0
1
2
3
4
5
Rehab Feeding Group
0
1
2
3
4
5
Sign Language
0
1
2
3
4
5
Tracheostomy
0
1
2
3
4
5
Ventilator
0
1
2
3
4
5
Videofluoroscopy
*
0
1
2
3
4
5
FEEST
0
1
2
3
4
5
Electronic Documentation
0
1
2
3
4
5
Electronic Documentation - List Types
Age of Patient Cared For
Newborn (birth - 30 days)
*
0
1
2
3
4
5
Infant (30 days - 1 year)
*
0
1
2
3
4
5
Toddler (1 - 3 years)
*
0
1
2
3
4
5
Preschooler (3 - 5 years)
*
0
1
2
3
4
5
School Age (5 - 12 years)
*
0
1
2
3
4
5
Adolescents (12 - 18 years)
*
0
1
2
3
4
5
Young Adults (18 - 39 years)
*
0
1
2
3
4
5
Middle Adults (39 - 64 years)
*
0
1
2
3
4
5
Older Adults (over 64+ years)
*
0
1
2
3
4
5
Information & Agreement
Application ID
*
Please enter your application ID. This ID should be 15 characters long and have the format of PHNMS##########. You should have received an email containing your application ID when you submitted your initial application. If not, please contact our staff.
Applicant Name
*
First
Last
Applicant Email
*
Applicant Phone
*
I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.
*
I agree to the terms below.
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Precision Nationwide Staffing. Submit this skills evaluation with your initial application. To be updated annually.
Signature
*