Genesys Clinical Hour Requests

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Current system time is 11/20/2009 06:57:36 PM

Request to work Additional Hours Request to Cancel Scheduled Hours \| View / Cancel Previous Requests

Employee Type: *	AA1 HRA LPN RN TECHNICAL RN - IABP SHEATH RN - SHEATH PULL SA OTHER

First Name: *		Last Name: *

Last 4 digits of SSN: *		Phone #: *

Date of Operational Shift: *	(Format: MM/DD/YYYY)

Operational Shift: *	7:00am - 3:15pm 3:00pm - 11:15pm 11:00pm - 7:15am

Preferred Hours:

Home Unit: *
2ST CICU L&D Postpartum Periop Float NICU Nursery OR PA Diagnostic Float PEDS PACU II Cath Lab MPU ER Float PACU I Rad Obs SWAT Float A ESTU Pain Clinic ADT ER EFC CRDC Rehab Resp (RT) ER WFC 4N 4S __ ER HP 2S Outpatient Revenue _ 2N GETS Remote Telemetry Float Inpatient CRC PRCU Float C Float B CVC MICU SICU WCC Float

Unit(s) Prefer to Work:
2ST CICU L&D Postpartum Periop Float NICU Nursery OR PA Diagnostic Float PEDS PACU II Cath Lab MPU ER Float PACU I Rad Obs SWAT Float A ESTU Pain Clinic ADT ER EFC CRDC Rehab Resp (RT) ER WFC 4N 4S __ ER HP 2S Outpatient Revenue _ 2N GETS Remote Telemetry Float Inpatient CRC PRCU Float C Float B CVC MICU SICU WCC Float

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