Cytology Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyGYNScreen : #/day(Required) 1 2 3 4 Review: #/day(Required) 1 2 3 4 NON-GYNAscitic Fluid(Required) 1 2 3 4 Bronchial(Required) 1 2 3 4 Esophageal(Required) 1 2 3 4 Gastric(Required) 1 2 3 4 Spinal(Required) 1 2 3 4 Urine(Required) 1 2 3 4 ThinPrepGYN(Required) 1 2 3 4 NON-GYN(Required) 1 2 3 4 FIXATIONSSaccomanno(Required) 1 2 3 4 Cytolyt(Required) 1 2 3 4 Carbowax(Required) 1 2 3 4 95% Alcohol(Required) 1 2 3 4 Filter Prep(Required) 1 2 3 4 Fine Needle AspirationsAssist(Required) 1 2 3 4 Make Smears(Required) 1 2 3 4 Collection(Required) 1 2 3 4 Preliminary Diagnosis(Required) 1 2 3 4 Onsite Procedures(Required) 1 2 3 4 Staining(Required) 1 2 3 4 SPECIAL STAINS/ORGANISMSGMS(Required) 1 2 3 4 PAP(Required) 1 2 3 4 IRON(Required) 1 2 3 4 Other Other SkillsFlow Cytometry(Required) 1 2 3 4 DNA Ploidy(Required) 1 2 3 4 FISH(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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