This checklist helps MAS Medical clearly outline your areas of expertise. Please complete this checklist as thoroughly as possible.

  • The Purpose of this checklist is to more clearly outline the Speech Therapist's areas of expertise. Please complete this checklist as thoroughly as possible.



  • Please check those areas you have experience in and comment on depth and breadth of experience where necessary.

    A. SPEECH/ LANGUAGE/ HEARING DISABILITIES

  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year

  • C. EXPERIENCE WITH AGE GROUPS


  • D. EXPERIENCE WITH SETTINGS

  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year
  • No ExperienceLess Than One YearMore Than One Year

    I am the individual completing this form. By checking this box I authorize MAS Medical Staffing to release this checklist to client facilities in consideration for employment.
  • This field is for validation purposes and should be left unchanged.