Foreign Application Form

Foreign Application Form
Personal Information
Name

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

MonthDayYear
Date
Contact Number
Format: (000) 000-0000.
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)

Other
Certifications (US certified only)

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?
If yes, please attach your NCLEX certification

Cancelof
English Proficiency
Have you taken an English proficiency test? (IELTS, TOEFL, etc.)
If yes, please provide test details
Score, date, etc.
If no, are you willing to take the exam?
Visa Eligibility
Have you ever applied for an H1B or EB3 visa before?
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)?
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