Foreign Application Form

Foreign Application Form
Personal Information
Name*

First NameLast Name
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Contact Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Educational Background
Nursing Degree/Diploma (Include School, Year of Graduation)*
License(s) Held (Include School, Expiration)*
License(s) Held (US certified only)*

Registered Nurse (RN) LicenseLicensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN) LicenseNurse Practitioner (NP) LicenseNurse Licensure Compact (NLC) Multistate LicenseCertified Registered Nurse Anesthetist (CRNA) LicenseCertified Nurse Midwife (CNM) LicenseClinical Nurse Specialist (CNS) LicenseOther
Certifications (US certified only)*

Basic Life Support (BLS)Advanced Cardiovascular Life Support (ACLS)Pediatric Advanced Life Support (PALS)Critical Care Registered Nurse (CCRN)Certified Emergency Nurse (CEN)Certified Neonatal Intensive Care Nurse (RNC-NIC)Certified Perioperative Nurse (CNOR)Certification in Infection Control (CIC)Other
Work Experience
Previous Employers (Name most recent employer)*
Specialties/Areas of Expertise*
ICU, Pediatrics, Emergency, etc.
Medical Records System Experience*
Name all applicable
Employment Status*
Attach Resume*

Cancelof
Attach Additional Documents

Cancelof
NCLEX Exam
Have you passed the NCLEX exam?*

YesNo
If yes, please attach your NCLEX certification

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English Proficiency
Have you taken an English proficiency test? (IELTS, TOEFL, etc.)*

YesNo
If yes, please provide test details
Score, date, etc.
If no, are you willing to take the exam?

YesNo
Visa Eligibility
Have you ever applied for an H1B or EB3 visa before?*

YesNo
If yes, please provide details
Status, outcome, etc.
Job Preferences
What is your preferred job location?
City, State
What is your preferred healthcare field and specialty?
Please articulate the types of roles and responsibilities desired.
Professional Qualifications
Do you have any additional certifications or training that would support your eligibility (e.g., BLS, ACLS, etc.)?
Are there any additional US certified qualifications or certifications that have been obtained.
Work Authorization
Do you have work authorization to work in the United States (If applicable)?

YesNo
Availability
When are you available to immigrate to the United States?
Virtual Interview Availability
Appointment*
Please verify that you are human*
Should be Empty:

Foreign Application Form

Personal Information

Educational Background

Work Experience

NCLEX Exam

English Proficiency

Visa Eligibility

Job Preferences

Professional Qualifications

Work Authorization

Availability

Virtual Interview Availability