Certified Medical Assistant Medical Assistant

Candidate Self Assessment

Personal Information

Please fill the Recruiter Email correctly for successful application submission.

Candidate Name

Email of Recruiter / POC

Select Submission Date

SSN (Last 4 digits)

Proficiency Scale & Legend

1 Clinicals Only

2 2 Years’ Experience

3 1 Year or Less Experience

4 3 Years + Experience

Skills

Check In

Referrals

Setting Appointments

Medical Records

EKG

Phlebotomy (adult)

Phlebotomy (child)

Spinning Blood

Calling RX

Vitals

Catheter I/O

Injections

Assisting Physician

Holter Monitors

MIMS (Medical Records)

Front Office

Back Office

Computer System

Please list any systems you have worked with

Specialized Experience

Specialized Experience (Please list any other specialized experience)

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency.