Form Application for Registration as a nurse

Form Application for Registration as a nurse
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Date of Birth

MonthDayYear
Date
Place of Birth
Marital Status

MarriedSingleWidowedDivorced
If Married give Maiden Name
Please provide the follwing to upload below:

Birth certificate
Certificate of Training
Transcript of Training
Certificate of Registration (If Trained outside Seychelles)
Evidence of Good Character/Professional Efficiency
Name and Address of two referees
Verification of Entry(ies) on professional register for nurses & midwives
Recent passport size photograph
Evidence of written & spoken English or French
Multiple Files Upload

Cancelof
Any other request of comments:
Click below to access Dataflow Website

https://dataflowgroup.com/organization/seychelles-nurses-and-midwives-council/
I Hereby request the Seychelles Nurses and Midwives Council to enter my name in the register or part of the register of Nurse, Midwife and others maintained by the Council.

NurseMidwifeOthers
I promise in the event of my being registered and in consideration thereof, to be bound by and to conform to the Rules and Regulations as laid down by the Council.

Confirm
Date

MonthDayYear
Date
Signature

Clear
Should be Empty: