Heavy Equipment Operator [Can read and work from construction plans]

Job Description Job Description Heavy Equipment Operators are the core of everything we do. You'll operate our fleet of excavators, dozers, loaders, and snowcats on active civil construction and snow removal projects — working alongside a skilled crew in one of Colorado's most dynamic mountain environments. This is a full-time, year-round position with real stability and a clear path forward. Responsibilities Operate excavators, dozers, loaders, snowcats, and other heavy equipment with precision and efficiency Execute civil construction tasks: site preparation, grading, excavation, backfill, and material placement Operate snow removal equipment on commercial properties and job sites in all winter conditions Inspect equipment before and after every shift — fluids, tracks, hydraulics, attachments, safety systems Perform minor field maintenance; communicate mechanical issues to the field mechanic promptly Maintain accurate equipment logs and daily timecard entries Collaborate with crew leads, laborers, and site managers to keep projects on schedule Qualifications [Required] Must be able to find grade and read construction plans Minimum 1 year hands-on experience operating excavators, bulldozers, loaders, or equivalent machinery Demonstrated ability to operate safely in varied terrain and weather conditions including snow and extreme cold Valid driver's license and clean driving record required; CDL a plus Working knowledge of equipment safety protocols and basic maintenance procedures Reliable, punctual, and a strong collaborator — our crews depend on each other Comfortable working at elevation and in mountain weather environments year-round High school diploma or equivalent required Compensation & Benefits $30.00 – $45.00 per hour , depending on experience. Benefits include employer-sponsored health insurance, 401(k) with matching, paid time off, up to $2,500 relocation assistance, company-paid Winter Park Resort ski season pass, and employee referral program. Company vehicle for Lead Operators. Significant overtime opportunity. Schedule: 40 hours/week minimum. Overtime may be required during active construction and snow removal seasons. Weekend and after-hours shifts possible based on project and weather demands. \nCompany Description Founded in 2001 and now led by Jeremy Straley and Mark Wallace, Mountain States Snowcats is a year-round heavy civil and snow management company with deep roots in Grand County and proven capacity across the Mountain West. Company Description Founded in 2001 and now led by Jeremy Straley and Mark Wallace, Mountain States Snowcats is a year-round heavy civil and snow management company with deep roots in Grand County and proven capacity across the Mountain West.

Home Health Aide/CNA

Job Description Job Description Benefits/Perks Flexible Scheduling Competitive Compensation Careers Advancement Job Summary We are looking for a Home Health Aide to join our team in Salem, MA! You will directly work with patients, following a one-on-one care plan in patient homes. You operate with a big heart, not only providing personalized and attentive care but by building genuine relationships with those you serve. You are detail-oriented, highly organized, and committed to creating a healthy environment that meets patient needs. Strong verbal and written communication skills are needed to succeed in this role. Prior Home Health or Certified Nursing Assistant is a plus. Responsibilities Assist patients with daily activities such as moving in and out of beds, baths, wheelchairs, or automobiles Care for patients by changing bed linens, doing laundry, cleaning the home, or assisting with personal care Maintain records of patient care, condition, progress, or problems to report and discuss observations with the supervisor Build relationships with patients by conversing or reading aloud to help keep them mentally healthy and alert Give medications and immunizations Engage patients in exercises or other activities Qualifications Graduated from an accredited Home Health Aide program High School Diploma or GED One year prior professional experience Driver’s license required CPR /First Aid certification required MAP certified a plus

Front End Loader Driver Operator

Job Description Job Description Join the largest locally owned and operated commercial waste and recycling company in Hawaii. Honolulu Disposal Service is seeking experienced CDL A and B Drivers to join our growing team. This position will be responsible for the hauling of waste services in a safe and timely manner while providing excellent customer service. Essential Job Functions • Communicate professionally with customers and co-workers • Adhere / follow ALL company "Safety" practices, policies and procedures, including DOT requirements • Follow directions and open communication with supervisors, dispatcher(s) and customers • Provide excellent customer service Requirements • Must have a valid Hawaii State Commercial Driver's license (CDL A or B) • Must be able to provide Driver History Record • Must be able to pass and complete a pre-employment DOT physical exam & drug test and be able to obtain a DOT Medical Examiner's Certificate. • Must be at least 21 years of age and be able to pass a criminal background check Compensation and Benefits • Competitive Hourly Wage Overtime Available • Schedule: Full Time/Part Time • Great benefits package including medical, dental, vision, 401(k) Profit Sharing Retirement Plan, Long Term Disability, vacation and sick pay, life insurance. Honolulu Disposal Service, Inc. is an equal opportunity employer minorities/females/veterans/disabled. We promote a drug free workplace. We're here for the long haul! Job Type: Full-time \nCompany Description Honolulu Disposal Service, Inc., founded in 1967 is now the largest waste hauling and recycling operation in Hawaii. Through over 50 years of business, we have grown from a two-truck operation to a full-service organization that employs hundreds of people and operates a modern fleet of refuse, recycling and service vehicles. Company Description Honolulu Disposal Service, Inc., founded in 1967 is now the largest waste hauling and recycling operation in Hawaii. Through over 50 years of business, we have grown from a two-truck operation to a full-service organization that employs hundreds of people and operates a modern fleet of refuse, recycling and service vehicles.

Experienced Grader Operator NOT JUST SOMEONE WHO CAN OPERATE A MACHINE

Job Description Job Description EXPERIENCED GRADER / EQUIPMENT OPERATOR 2 POSITIONS AVAILABLE $48,000–$65,000 PER YEAR YEAR-ROUND WORK • GUARANTEED SALARY • PAID WEEKLY Austin Farms Sodding is a Missouri sod farm with more than 30 years in business. We are looking for two experienced graders/equipment operators for stable, year-round positions. WE'RE LOOKING FOR A GRADER — NOT JUST SOMEONE WHO CAN OPERATE A MACHINE. If you know how to establish drainage, create proper slopes and elevations, perform quality rough and finish grading, and leave a property ready for sod, we want to talk to you. SALARY BASED ON EXPERIENCE AND DEMONSTRATED GRADING ABILITY • $48,000–$50,000: Experienced equipment operator with 3 years of experience and the ability to perform grading work • $50,000–$58,000: Experienced grader with 5 years of experience , capable of rough and finish grading, establishing drainage, and working with slopes and elevations • $58,000–$65,000: Highly skilled grader with 10 years of experience , who can independently establish elevations, slopes and drainage and consistently produce excellent finish grades Starting salary is based on experience, demonstrated grading ability, quality of work, and overall skill level. GUARANTEED YEAR-ROUND SALARY This is a salaried, year-round position. If rain, snow, wet ground or other weather conditions prevent us from working, you still receive your regular salary. COMPENSATION & BENEFITS • Guaranteed year-round salary regardless of weather • Paid weekly by direct deposit • 401(k) with up to a 4% company match • $1,000–$3,000 annual Christmas bonus • Additional 4% company 401(k) match associated with the Christmas bonus • Modern, state-of-the-art grading and compact equipment • Company-provided cell phone with unlimited talk, text and data • Paid holidays • One week of paid vacation after one year • Saturdays generally off, with limited Saturday work as needed, typically a few times per year • No required Sunday work except when snow removal is necessary • Annual opportunity for performance-based raises • Annual employee recognition awards and cash bonuses for outstanding performance RESPONSIBILITIES • Operate Bobcats, tractors and other compact equipment • Operate tractors with box blades • Perform rough and finish grading • Establish and correct drainage • Establish proper slopes and elevations • Prepare soil for sod installation • Read and understand grade and elevation requirements • Perform daily equipment inspections and basic maintenance • Operate a snowplow truck during the winter QUALIFICATIONS • Minimum 3 years of grading/equipment operating experience • Bobcat or similar compact equipment experience • Tractor and box blade experience preferred • Rough grading, drainage and/or finish grading experience • Valid Missouri Class E driver's license • Able to meet DOT physical requirements • Good driving record preferred • Dependable, reliable and safety-conscious • Able to work independently • Takes pride in quality workmanship • Snow removal during the winter WE'RE LOOKING FOR A GRADER — NOT JUST SOMEONE WHO CAN OPERATE A MACHINE. There's a big difference between simply moving dirt and knowing how to grade a property correctly. If you can look at a job and know how to establish drainage, set elevations, create proper slopes and leave a quality finish grade , we want to talk to you. If you're a skilled grader looking for stable, year-round work with a company that values quality workmanship , give us a call. Austin Farms Sodding 1120 SE Century Dr. Lee's Summit, MO 64081 We take PRIDE in our people, our work, and our commitment to Attitude, Flexibility and Superior Performance. \nCompany Description Landscape, Irrigation and Sod company. Company Description Landscape, Irrigation and Sod company.

Large Lift Heavy Equipment Operator

Job Description Job Description Wheel Loader Operator / Yard Truck Driver (Hybrid Position) Job Summary We are seeking a dependable, safety-focused Wheel Loader Operator / Yard Truck Driver to join our lumber yard operations team. This hybrid role is responsible for the safe movement, loading, unloading, staging, and transportation of lumber products throughout the facility using wheel loaders, yard trucks, trailers, and other mobile equipment. The ideal candidate will be comfortable operating heavy equipment in a fast-paced outdoor environment, coordinating truck movements, maintaining inventory flow, and supporting production and shipping operations. Safety, situational awareness, and attention to detail are essential for success in this position. Essential Duties and Responsibilities Wheel Loader Operations Operate wheel loaders to move, stack, load, and unload lumber, wood products, and related materials. Transport materials between storage yards, production areas, and shipping locations. Maintain safe and efficient traffic flow within the yard. Perform pre-operational inspections and daily equipment checks. Monitor load stability and ensure proper material handling practices. Assist with inventory organization and yard housekeeping. Yard Truck (Jockey) Operations Safely move trailers between loading docks, storage areas, and staging locations. Spot trailers for loading and unloading operations. Verify trailer placement and secure equipment according to company procedures. Coordinate with shipping, receiving, and production personnel to ensure timely trailer movement. Conduct daily inspections of yard trucks and report maintenance issues. General Yard Responsibilities Assist with loading and unloading customer and supplier vehicles. Follow all site traffic control procedures and designated travel routes. Maintain accurate communication with loaders, forklift operators, truck drivers, and supervisors. Participate in inventory counts and yard audits as needed. Keep work areas clean, organized, and free of hazards. Support production and shipping operations as required. Qualifications Required Minimum 2 years of experience operating heavy equipment, wheel loaders, forklifts, or similar machinery. Experience operating yard trucks, terminal tractors, or trailer jockey equipment preferred. Ability to work safely around moving equipment, trucks, and personnel. Strong understanding of workplace safety procedures. Ability to work outdoors in varying weather conditions. Ability to lift up to 50 pounds occasionally. Reliable attendance and strong work ethic. Schedule Full-Time Monday through Friday Overtime and occasional weekends may be required based on production and shipping demands. Day shift

Heavy Equipment Operator

Job Description Job Description Heavy Equipment Operator – Yard & Marine Operations Company: Olde Yankee Inc. Location: Philadelphia, PA (Primary) with Seasonal & Occasional Travel to Port Norris, NJ Job Type: Full-Time Compensation: Competitive Hourly Pay (Based on Experience) Overtime Opportunities About Olde Yankee Inc. Olde Yankee Inc. is a growing industrial services company specializing in construction materials, aggregate handling, marine logistics, waterfront operations, heavy equipment services, and industrial support throughout the Mid-Atlantic region. Our team supports a diverse range of operations, including construction material handling, marine terminals, barge transportation, vessel support, and industrial maintenance. We are committed to safety, teamwork, and providing exceptional service to our customers. We are seeking a dependable, motivated, and safety-conscious Heavy Equipment Operator to join our growing team. This position offers the opportunity to work in both a busy industrial yard and an active marine environment while operating a variety of heavy equipment and supporting marine and construction operations. Position Summary The Heavy Equipment Operator is responsible for the safe and efficient operation of heavy equipment while supporting daily yard operations, marine terminal activities, inventory management, equipment maintenance, and general facility operations. Working alongside operations management, dispatch, mechanics, truck drivers, laborers, and vessel crews, this position plays an essential role in keeping our operations running safely and efficiently. This position is primarily based in Philadelphia, Pennsylvania , with seasonal and occasional travel to our Port Norris, New Jersey facility to support marine, yard, and vessel operations as business needs require. Essential Duties & Responsibilities Heavy Equipment Operation Safely operate front-end loaders, excavators, skid steers, forklifts, telehandlers, material handlers, and other heavy equipment. Load and unload trucks, barges, and construction materials. Build and maintain aggregate stockpiles. Move equipment and materials throughout the yard and terminal. Perform grading, cleanup, and site maintenance. Operate equipment safely around employees, contractors, customers, and active work zones. Marine & Waterfront Operations Assist with loading and unloading barges and marine vessels. Support dockside material handling operations. Operate heavy equipment within active marine terminals. Assist with marine construction and dredging support activities. Support vessel crews during cargo transfers. Assist with equipment staging, barge movements, and waterfront maintenance. Equipment & Facility Maintenance Perform daily pre-operation and post-operation inspections. Fuel, grease, clean, and perform routine preventative maintenance. Report mechanical issues or equipment damage promptly. Maintain equipment in safe operating condition. Assist mechanics with repairs as needed. Help maintain roads, fueling stations, wash areas, and equipment storage locations. Yard Operations Maintain a clean, organized, and safe work environment. Assist with inventory management and material organization. Keep roadways and access points clear. Support plant and facility maintenance projects. Assist other departments as operational needs require. Safety & Compliance Follow all OSHA, DOT, Coast Guard, MSHA (where applicable), and company safety policies. Wear required personal protective equipment (PPE). Complete equipment inspections and operational paperwork. Participate in safety meetings and ongoing training. Immediately report unsafe conditions, accidents, or equipment issues. General Responsibilities Communicate effectively with dispatch, operations, mechanics, truck drivers, laborers, and management. Maintain professional relationships with customers, vendors, and contractors. Complete paperwork accurately and in a timely manner. Perform additional duties and special projects as assigned. Travel Requirements Primary work location: Philadelphia, PA. Seasonal and occasional travel to our Port Norris, NJ facility is required based on operational needs. Travel may involve supporting: Marine terminal operations Barge loading and unloading Equipment transfers Yard operations Vessel support Maintenance and special projects Company vehicle or mileage reimbursement provided when applicable. Qualifications Required High School Diploma or GED. Valid driver's license with a satisfactory driving record. Minimum of 2 years of heavy equipment operating experience . Ability to safely operate multiple types of heavy equipment. Strong communication and teamwork skills. Reliable attendance and strong work ethic. Ability to work outdoors in all weather conditions. Ability to pass a pre-employment drug screening, physical examination, background check, and motor vehicle record review. Preferred Experience operating loaders, excavators, forklifts, telehandlers, or material handlers. Experience working in construction, aggregate, marine terminals, ports, or industrial environments. Commercial Driver's License (Class A or B). TWIC Card (or ability to obtain one). Mechanical, welding, or fabrication experience. Physical Requirements Frequently stand, walk, bend, kneel, squat, climb, and reach. Climb on and off heavy equipment throughout the workday. Lift and carry up to 50 pounds. Work safely around moving equipment, trucks, barges, and industrial machinery. Ability to work outdoors in varying weather conditions. Schedule Monday–Friday Day Shift Overtime available based on operational needs Occasional evenings and weekends as required Benefits Competitive hourly pay based on experience Overtime opportunities Health Insurance Vision Insurance 401(k) with Company Match Paid Vacation Paid Holidays Paid Time Off (PTO) Company-paid safety training Career advancement opportunities Stable, year-round employment Why Join Olde Yankee Inc.? At Olde Yankee Inc. , you'll become part of a team that supports critical construction, industrial, and marine infrastructure projects throughout the region. We invest in our employees by providing modern equipment, ongoing training, opportunities for advancement, and a collaborative work environment where safety and professionalism come first. If you're looking for a long-term career with a growing company that offers diverse work, competitive pay, and opportunities to grow, we'd love to hear from you. Apply Today! Take the next step in your career with Olde Yankee Inc. and become part of a team that takes pride in building and supporting the infrastructure that keeps our region moving. \nCompany Description Castor Materials Inc. is a family-owned and operated ready-mix concrete company proudly serving Philadelphia and the surrounding Delaware Valley. Since 2004, we have grown from a single dry-batch plant into an established concrete producer with multiple locations, a large fleet of front-discharge concrete mixers, and the equipment and capabilities to serve both commercial and residential projects. Our continued growth is built on reliability, quality, customer service, and a hardworking team. We operate and maintain our own fleet of concrete mixer trucks, tri-axles, heavy equipment, and support vehicles, allowing our employees to play an important role in keeping our operation moving every day. At Castor Materials, we value dependable employees, long-term relationships, and people who take pride in their work. As a family-owned company, we strive to provide a workplace where employees are recognized for their contributions and have opportunities to grow with the company. Company Description Castor Materials Inc. is a family-owned and operated ready-mix concrete company proudly serving Philadelphia and the surrounding Delaware Valley. Since 2004, we have grown from a single dry-batch plant into an established concrete producer with multiple locations, a large fleet of front-discharge concrete mixers, and the equipment and capabilities to serve both commercial and residential projects.\n\nOur continued growth is built on reliability, quality, customer service, and a hardworking team. We operate and maintain our own fleet of concrete mixer trucks, tri-axles, heavy equipment, and support vehicles, allowing our employees to play an important role in keeping our operation moving every day.\n\nAt Castor Materials, we value dependable employees, long-term relationships, and people who take pride in their work. As a family-owned company, we strive to provide a workplace where employees are recognized for their contributions and have opportunities to grow with the company.

Water Recycle Operator

Job Description Job Description Reports to: Field Supervisor Classification: Non-Exempt Location: Odessa Texas /Knott Summary You will be responsible for a wide range of tasks including training, troubleshooting, inventory control, and ensuring the safe handling of chemicals utilized during production and water recycling. Essential Functions Following directions and reporting to the Supervisor or Manager for daily tasks and projects. Participating in training sessions and educational programs related to specialized projects and chemical program improvements. Conducting surveys, troubleshooting, and reporting on chemical treatment processes and issues encountered. Maintaining inventory control and assisting in troubleshooting and problem-solving related to inventory. Ensuring proper setup and connection of equipment, conducting inspections, and identifying and repairing leaks as needed. Identifying safety hazards, reporting them using electronic methods, and maintaining a safe work environment. Conducting accurate inventory checks on chemicals and reporting to management. Handling hazardous chemicals safely and using the appropriate personal protective equipment (PPE). Replace filter socks as needed. Performing water sample analysis, adjusting chemical dosages, and maintaining proper treatment processes. Collecting and analyzing water samples from various sources and conducting preventive and emergency equipment maintenance. Adhering to health, safety, and environmental policies and procedures at all times. Communicating effectively with customers, supervisors, and management both verbally and in writing. Ensuring timely and accurate reporting on all activities and maintaining a clean and organized work area. Qualifications To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Will be required to work evenings, weekends, holidays and nights as required for the position. Must understand and adhere to all company, federal and state rules, policies and safety regulations. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience High school diploma or general education degree (GED familiarity with oilfield operations and safety regulations is a plus, light mechanical skills, strong verbal and written communication skills, demonstrated problem solving skills, the ability to prioritize and multitask with speed and accuracy and work independently for prolonged periods of time. You must have the ability to pass a criminal background check, MVR and drug screen. Must be 23 years of age or older. Preferred skills include experience with chemical handling and treatment on a frac site. Language: Ability to read, write and comprehend maps, customer instructions, written safety instructions, manuals, procedures, equipment instructions. Math Ability: To perform simple addition, subtraction, multiplication and division. Reasoning Ability: Ability to apply common sense understanding to carry out detailed written or oral instructions, define and solve problems, respond to rapidly changing circumstances, problem solving skills. Computer Skills: To perform this job successfully, an individual should have professional written communication on a mobile device or tablet (i.e. email, text, etc.). Certificates and Licenses: Class C Driver’s License Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is consistently exposed to work near moving mechanical parts, chemicals, gases, dust and fumes. The employee is frequently exposed to wet, hot, cold and other moderate to extreme weather conditions. The noise level in the work environment is usually moderate to loud. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must regularly lift and /or move up to 50 pounds. While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl and talk or hear. The employee is frequently required to climb or balance. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and/or skills required of all employees within this class. Accommodations: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Certified Nurses Assistant

Job Description Job Description Certified Nursing Assistant (CNA) – PRN Location: Bangor, Maine Schedule: PRN (As Needed) Shift: 6:30 AM – 7:00 PM Position Summary We are seeking a dependable and compassionate Certified Nursing Assistant (CNA) to join our healthcare team on a PRN basis in Bangor, Maine. The ideal candidate will have experience providing quality patient care and supporting residents with activities of daily living while maintaining a safe and comfortable environment. Responsibilities Assist residents/patients with daily living activities, including bathing, dressing, grooming, toileting, and feeding. Monitor and report changes in residents' physical or emotional condition. Take and record vital signs as directed. Assist with mobility, transfers, and positioning. Maintain accurate documentation and communicate effectively with the healthcare team. Provide compassionate, patient-centered care while preserving resident dignity and confidentiality. Follow all facility policies, infection control procedures, and safety protocols. \nCompany Description About JayKay Medical Staffing: Jaykay Medical Staffing has successfully been providing talent recruitment for more than 18 years, with our recruiters bringing more than 25 years of experience, specializing in the placement of healthcare professionals for clients in all 50 states. Here at Jaykay Medical Staffing we pride ourselves in being the visionary leaders of the Health Care Staffing world. We seek the most gifted candidates in the healthcare field with our primary focus on helping them find their dream job. Whether that describes you or the employee you are looking for, we are here to meet all of your staffing needs. Company Description About JayKay Medical Staffing:\r\n\r\nJaykay Medical Staffing has successfully been providing talent recruitment for more than 18 years, with our recruiters bringing more than 25 years of experience, specializing in the placement of healthcare professionals for clients in all 50 states. Here at Jaykay Medical Staffing we pride ourselves in being the visionary leaders of the Health Care Staffing world. We seek the most gifted candidates in the healthcare field with our primary focus on helping them find their dream job. Whether that describes you or the employee you are looking for, we are here to meet all of your staffing needs.

Certified Nursing Assistant (CNA)

Job Description Job Description We are seeking a CNA PRN to become a part of our team! You will provide routine healthcare to patients at the patient's home or in a care facility. Responsibilities: Provide direct patient services that are ordered by the physician, included in the plan of care, permitted to be performed under state law, and consistent with the home health aid training. Provides care under the direction and supervision of the RN or therapist and in accordance with the Home Health Aide Care Plan Provide hands-on personal care and support services as assigned and per the Agency policies. Provide assistance to patients with ambulation, safe transfers and exercises as assigned and per the Agency policies Provide personal care, such as bathing and dressing patients Provide assistance with medications ordinarily self administered. Appropriately report changes in the patient's condition to a registered nurse and documents pertinent information and care rendered to patients to ensure continuity of care Qualifications: Experience in hospice, home health, or other related fields Positive and patient demeanor Ability to build rapport with patients Ability to handle physical workload Excellent written and verbal communication skills Must be bilingual Must have transportation with car insurance \nCompany Description At Envision, we believe every person deserves peace and comfort, with care that emphasizes independence and respect and is tailored to their preferences. Since 2005, we’ve embraced every person who needs medical care. We provide each individual with an entire team including doctors, nurses, social workers, and support staff who all have a relentless passion to ease the physical, and emotional pain of any person in our community. Our team offers kindhearted care and expert education, from friendly caregivers to professional medical staff. Company Description At Envision, we believe every person deserves peace and comfort, with care that emphasizes independence and respect and is tailored to their preferences.\r\nSince 2005, we’ve embraced every person who needs medical care. We provide each individual with an entire team including doctors, nurses, social workers, and support staff who all have a relentless passion to ease the physical, and emotional pain of any person in our community. Our team offers kindhearted care and expert education, from friendly caregivers to professional medical staff.