Internet
Pediatric Nurse
Application 

Please answer these questions as candidly as possible.  Thank you very much.   For your protection your data will be encrypted when sent. (SSL Secure Server)
  

Your Email Address:       Your Phone Number:

Your Age (optional):          Your Gender:  Male      Female

What is the main reason that you have applied for the Online Pediatric Nurse position? (Please be candid, pick one)
I am looking for a new job.
I am looking for additional work.
I like that I can be located anywhere.
I like the flexible hours.
I like that I can work from home.
I am interested in the Internet as a way to deliver healthcare.
I see the Internet as a way to combat childhood obesity.
Other (Please specify)

Your Current Work Setting (Pick one)
School
Clinic/Physician Office
Hospital
Public/Community Health
Industry/Corporation
Unemployed
Other (Please specify)

Your Primary Area of Specialization (Pick one)
Outpatient Nursing
Hospital Nursing
Child / teen weight loss program
Adult weight loss program
Informatics
Eating disorders program
Other (Please specify)

Number Hours Per Week You Are Seeking (Optional, but this would give us some idea)
5-10
11-15
16-20
21-25
26-30
>30

Hourly Compensation Level You Are Seeking (Optional, but this would give us some idea)
$20
$25
$30
$35
$40
$45
$50
Other (Please specify)

What is your Internet Experience? (Check all that apply)
I use the Internet for personal email.
I use search engines.
I refer my clients/patients to the web for additional resources.
I use email to communicate with my clients/patients.
I use bulletin boards, chat rooms, and/or instant messaging.
I am web page design knowledgeable, e.g. Front Page, HTML.
I am graphics design knowledgeable, e.g. Photoshop.
I have worked for a web site.
I have created my own web site.
Other (Please specify)

What is your Internet connection type, where you would perform this job?
Dial-up 
DSL 
Cable 

How do you feel about providing advice over the Internet? (Check all that apply)
I am comfortable providing static information (e.g. website articles, Q & A), but not one-on-one advice.
I am comfortable providing one-on-one advice, but only if I could see the child face-to-face in an office, as well.
I am comfortable providing non-face-to-face, one-on-one advice, provided that the child, parents, and the child's healthcare provider agree to the limitations of online interaction.
I am comfortable providing group advice to teens and preteens in a live chat room, without seeing them face-to-face.
I am not comfortable providing non-face-to-face, one-on-one advice via the Internet because of liability concerns.
I am not comfortable providing non-face-to-face, one-on-one advice via the Internet because of licensure / regulatory concerns.
I am not comfortable providing non-face-to-face, one-on-one advice via the Internet because of quality concerns (face-to-face interaction is required).
Other  (Please specify)

How would you respond to the following message from a 14 year old girl, who is 5'4" and weighs 260 lb?

"hey, whats up? i've tried everything to lose weight and nothing works. . i cant stop eating... i have cravings for food but i dont even no what i want, and even after i eat i always feel hungry.  food is like my comfort.. so i just keep eating and eating. .  i really want to be in control of my weight, but i don't know how!  please give me some tips... im despirate!!! "

Your response:

Other skills or experience which you have, which you would feel would be useful for this position.

Please check your answers.  When you have completed the application, please click "SUBMIT APPLICATION".  Thank you very much.