Prime Healthcare Services
  • About Prime
  • Find A Job
  • Benefits
  • Find Staff
    • Prime Service
    • Staff Request Form
  • Apply Now
    • Fast Form
    • Full Application
    • Skills Checklist
  • Education Staffing
  • Contact

Physical Therapist Skills Checklist

Please fill out and submit the online Skills Checklist below.

You can also click here to download a PDF version of this form to fill out offline, and mail or fax it to us.
Mail: Prime HealthCare Staffing - 27240 Haggerty Road, Suite E-15 - Farmington Hills MI 48331
Toll Free Fax: 866-992-0900

First Name:
Last Name:

Please indicate how many years/months of professional work experience you have in the following settings.
If you have no work experience in a category please indicate 0. If experience was in your clinicals/internship ONLY, indicate C.


GENERAL WORK SETTING EXPERIENCE
Setting Length

Setting

 Length Setting Length Setting Length
Hospital-General Acute NICU Day Rehab University /College
Hospital-Trauma Acute Peds-Inpatient Home Health Adults Research
Hospital-Sub-acute Peds-Outpatient Ortho Home Health Peds Long Term Acute Care
Hospital-Inpatient Rehab Peds-Outpatient Developmental Industrial Rehab Group Homes
Hospital-Outpatient Neuro Early Intervention Workers' Comp Skilled Nursing Facility
Hospital-Outpatient Ortho Headstart Program Fitness Center Assisted Living
Outpatient-Sports Medicine Schools (K-12) Professional Sports Community Program

Please use the key below for the remainder of this checklist. Check the appropriate box that best describes your skill level in each of the following categories:

A. No experience B. Clinical experience only C. Intermittent/previous experience D. Less then 2 years of experience
E. 2+ years of experience F. 10+ years of experience/can teach


AGE SPECIFIC PRACTICE
AREA A B C D E F AREA A B C D E F
Newborn (birth-30 days) School Age (5-12 years)
Infant (30 days-1 year) Adolescents (12-18 years)
Toddler (1-3 years) Adults
Preschooler (3-5 years) Geriatrics
A. No experience B. Clinical experience only C. Intermittent/previous experience D. Less then 2 years of experience
E. 2+ years of experience F. 10+ years of experience/can teach


GENERAL EXPERIENCE
NEUROLOGICAL A B C D E F SPECIALTIES A B C D E F
Brain Tumor Aqua Therapy
Cerebral Vascular Accident (CVA) Burn Management
Neurodevelopmental Disorders Craniosacral Therapy
Parkinson's Ergonomic Training
Spasticity Management Industrial Rehabilitation
Spinal Cord Injury (SCI) Manual Therapy
Traumatic Brain Injury (TBI) Wound Debridement
ORTHOPEDIC A B C D E F OTHER A B C D E F
Arthritis AIDS/HIV
Back Injuries Amputee
Fractures Cancer
Hands-Nerve Injury Cardiac Rehabilitation
Hands-Tendon Repair Cognitive Rehabilitation
Neck Injury Developmental Disabilities
Orthotics Prescription Education-Family
Prosthetics Fitting and Training Education-Patient
Progressive Strengthening Gait Disorders
Osteoporosis Musculoskeletal Conditions
Shoulder Injury PPS
Sports Injuries RUGS
Temporal Mandibular Joint Dysfunction (TMJ) Student Supervision
Total Hip/Knee Replacement Vent/Trache
A. No experience B. Clinical experience only C. Intermittent/previous experience D. Less then 2 years of experience
E. 2+ years of experience F. 10+ years of experience/can teach


MODALITIES/TREATMENT TECHNIQUES/ASSESMENTS/EVALUATIONS
AREA A B C D E F AREA A B C D E F
Adaptive Equipment Muscle Stimulation
Biofeedback Myofascial Release
Bracing NDT
BTE Orthotics
CPM Paraffin Bath
Crutch Training Prosthetics
Cryotherapy Splints
Edema Massage Taping
Energy Conservation Traction
Fluidotherapy TENS
Hydrotherapy Ultrasound
Joint Mobilization Valpar
Mckenzie Work Capacity Evaluation
Maitland
A. No experience B. Clinical experience only C. Intermittent/previous experience D. Less then 2 years of experience
E. 2+ years of experience F. 10+ years of experience/can teach


PEDIATRICS
AREA A B C D E F AREA A B C D E F
ADD/ADHD Emotionally Impaired
Asperger's Syndrome Hearing Impaired
Autism Spectrum IEP Development
Behavioral Difficulties General Weakness
Cerebral Palsy Medical Model/Private Practice/Outpatient
Cognitively Impaired NICU Treatment
Coordination Disorder Orthopedic
Degenerative Disorders Physical Disabilities
Developmental Delay Sensory Processing Deficits/Sensory Motor
Down's Syndrome Spina Bifida
Educational Model/Schools Visually Impaired
A. No experience B. Clinical experience only C. Intermittent/previous experience D. Less then 2 years of experience
E. 2+ years of experience F. 10+ years of experience/can teach


PEDIATRIC ASSESSMENTS/EVALUATIONS/TECHNIQUES

AREA

A

B

C

D

E

F

 AREA A B C D E F
Adaptive Equipment Orthopedic Treatments
Bracing Orthotics
Gait Training Prosthetics
Gross Motor Assessment Tools Standardized Testing
Mobilization Techniques Strengthening
Neurodevelopmental Techniques (NDT) Walker Assessments/Training
Orthopedic Assessments Wheelchair Assessments/Training
A. No experience B. Clinical experience only C. Intermittent/previous experience D. Less then 2 years of experience
E. 2+ years of experience F. 10+ years of experience/can teach


Please list any special certifications you have, and skills or comments that you feel would help us find the proper placement for you.
Please read the following before submitting this survey
I verify that this statement of my work experience is accurate to the best of my knowledge.

I give my permission to Prime HealthCare Staffing to use this information while making appropriate job placements for me.
I understand this may include releasing this information to potential customers, upon request, during the assignment process.

I have read and agree to the above statements.