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* 1. Please enter your contact information

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* 2. What is your skillset/professional designation?

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* 3. Do you possess a current NYS Professional License?

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* 4. If you do possess a current NYS Professional License, please enter the #

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* 5. Can you work at a local, to be determined) UC surge facility (hospital or other)?

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* 6. How many days per week (1-7) would you be available to work/volunteer?

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* 7. Can you work weekdays, weekends, or both?

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* 8. Are there any days of the week that you CANNOT work (check as many as apply)?

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* 9. Can you work day, evening and overnight shifts (check as many as apply)?

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* 10. Shift durations are either 4-hour or 8-hour. Please select your preference

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