Application form

Licensed Respiratory Therapist

PRN (as needed)

Experience, Knowledge and Skill

Previous Experience Required:

- One year of hospital experience preferred.

- Knowledge of respiratory therapy services.

Specialized or Technical Education Required:

- Current Louisiana respiratory therapist license (CRT or RRT) or permission to practice required.  RRT must have NBRC.

- Must have immediate access to license while on duty, actively registered with the National Board for Respiratory Care (NBRC) required.

- Current BLS with preferred ACLS and PALS.

- Must adhere to the guidelines set forth by the Louisiana State Board of Medical Examiners and annual SWANK and/or hospital requirements.

Manual or Physical Skill Required:

- Must have good written and oral communication skills.

- Must be able to speak and interact effectively with people.  

- Must exhibit excellent professional and personal ethics.  

- Must be able to maintain professionalism, good judgment, reasoning and communication skills while in stressful situations.  

- Requires the highest degree of respiratory therapy service and communication abilities.

Physical Effort Required/Physical Demands:

- Requires the ability to assist in lifting and transferring patients.

- Must be able to move about to all hospital departments.  

- Must be able to work at either sitting or standing at a computer to input patient information.  

Strength:  Light; Push:  Frequently; Pull:  Frequently

Carry:  Occasionally; Lift:  Occasionally; Sit:  Frequently

Stand:  Frequently; Walk:  Frequently

Personal Information

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Referral Information

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Placement Information

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High School

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Graduate School

Vocational School/ Other

Certifications / Licenses

License 1

License 2

License 3

License 4

Skills & Qualifications

Employment History

Current Employer

Previous Employer 1

Previous Employer 2


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Reference 1

Reference 2

Reference 3

Applicants Statement

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  1. I verify that all information on my application, resumes, and exhibits submitted to Hood Memorial Hospital are true, correct, and complete and any false or misleading information furnished by me regarding my application will be sufficient cause for rejection of application or immediate dismissal if employed by Hood Memorial Hospital. 
  2. I verify that my application is not a job offer or a contract for employment.  If hired, I understand that any employment will be “at will” and for an indefinite time period.  I understand that I may resign or be terminated by the facility at any time without notice or requirement for cause. 
  3. I verify that I authorize persons, schools, organizations, my current employer and previous employers (unless otherwise noted) named in the application and accompanying resume to provide any relevant information that may be required to arrive at an employment decision. 
  4. I verify that employment may be subject to completion of preemployment procedures including, but not limited to, employment /personal references, background investigation, criminal records check, driving record verification (if applicable) and licensure /registration/ certification verification (if applicable).
  5. I understand that during my employment, if hired, I will report to my immediate supervisors any drug-related criminal conviction within five days of the conviction. 
  6. I understand that following an offer of employment, I may be required to undergo a health assessment.  This examination may include, but is not limited to, screening for infections, diseases, alcohol, and drugs.  Failure to undergo and/or pass the health assessment will result in disqualification from employment.  Failure to truthfully answer inquiries about previous medical conditions may result in my forfeiture of Worker’s Compensation benefits under R.S.23:1208.1.
  7. If accepted for employment, I hereby agree to abide by the rules, policies, procedures, and Customer Service standards of Hood Memorial Hospital. 
  8. I understand, if hired, I will be on a three-month initial evaluation period (unless otherwise defined) during which time I may be discharged without recourse.
  9. If hired, I understand that my hours of employment and work schedule may be changed at the discretion of Hood Memorial Hospital.

My typed name shall have the same force and affect as my written signature.

Note: Review the entire form to be sure no questions have been omitted if required.
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