Phlebotomist Skills Checklist

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 No experience

2 Limited Experience

3 Experienced

4 Highly Skilled

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.

Phlebotomist Skills Checklist

Personal Information

Proficiency Scale & Legend

Patient Identification:

Equipment

General

Complications/troubleshooting

Techniques

Transport