Nurse Manager Supervisor Skills Checklist

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 No Experience / Observed Only

2 Limited Experience / Rarely Done (<6 times/year)

3 May Need Some Review / Occasionally Done (1 - 2 times/month)

4 Experienced / Frequently Done (daily or weekly)

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)

Infant (31 days to 12 months)

Toddler/Preschool (13 months to 5 years)

School Age Child/Adolescent (6 years to 18 years)

Young Adults/Middle Adult (19 years to 64 years)

Older Adults/Elderly (65+ years)

General Skills Electronic Documentation:

Environments

Management

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.