New Grad RN Interview Questionnaire
*Indicates Required Field
Name
*
First Name
Last Name
Current Location
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Questions & Details
Nursing School Graduation/Expected Graduation Date
*
-
Month
-
Day
Year
NCLEX Status
*
Passed
Scheduled
Not yet Scheduled
RN Licensed State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
OPT Approved Start Date
-
Month
-
Day
Year
Skip if no approved OPT
OPT Expected Start
-
Month
-
Day
Year
Enter Date you requested or plan to request
Do you have your EAD Work Permit?
*
Yes
No, still waiting to be issued
No, have not yet applied
Do you have a Social Security Card
*
Yes
No
What US State(s) will you accept a nursing assignment?
*
California
Texas
Illinois
New York
All of the above
None of the above
What is your immigration status?
*
Is there anything else you would like us to know about you?
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