Health Care Professional Screening Questionnaire
This form allows RestUp to do a better job serving your professional goals and intent for using the RestUp platform.
Email address *
What is your first name? *
What is your last name? *
What is your phone number? *
Tell me why you signed up to be a Caregiver with RestUp? *
What is the length of your ideal shift? *
Required
What is the timing of your ideal shift? *
Required
What days of the week are ideal for you to work extra shifts? *
Required
How many hours are you hoping to get through RestUp? *
What’s your preferred Health Care Facility setting? *
Are there any HCF settings you are not willing to work in? *
Do you have any restrictions or limitations on the type of work you can do? *
Do you have your own professional HCF attire? Nametag? Equipment? (pen, stethoscope, pulse ox, BP cuff, etc.) *
Do you acknowledge that while working on the RestUp app you are working as an independent contractor?
Clear selection
Do you carry professional liability insurance? *
Do you promise to abide by RestUp's user rules which include the following: (1) If a Users resigns from a shift within 24 hours of the start time of the shift, the user shall be deactivated. (2) If a Users does not show up for a shift, the user will be deactivated. (3) If there is a complaint from a facility about the User's conduct while working a shift, the User may be deactivated.
Clear selection
Do you promise to cooperate with Covid-19 testing at the long term care facilities you work at? (RestUp health care professionals must be tested in accordance with CMS-3401-IFC in order to remain activated on the RestUp platform.)
Clear selection
Do you promise to report to RestUp immediately if you test positive for Covid-19?
Clear selection
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