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Oversea Nurses Registration Form
This form is strictly for registered oversea nurses who want to register with ClickNurse.
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1
Full Names
*
This field is required.
Please, enter your full names below
Prefix
First Name
Middle Name
Last Name
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2
E-mail
*
This field is required.
Please, enter your best email here
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3
Mobile Contact Number (Including Country Code)
*
This field is required.
Ensure that you enter your country code first before your contact number
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4
Sex
*
This field is required.
Please, scroll and select the applicable
Please select the appropriate
Male
Female
Please Select
Please select the appropriate
Male
Female
Please, select one option
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5
Birth Date
*
This field is required.
Type in your date of birth in the following format
-
Day
Month
Year
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6
Full Contact Address
*
This field is required.
Please, fill in your full contact address here. This may be your correspondence or Home address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Philippines
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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7
ID Document: eg International Passport
*
This field is required.
Please,Upload Your Passport Document Here.
Drag and drop files here
Select files to upload
Upload a File
File should be in jpg format
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8
Do you have IELTS/OET test results to the required standard for NMBI registration? If yes, state your test scores. If No, please do not proceed further with this form
*
This field is required.
Please, state your IELTS/OET test score
For example: IELTS Test: L=7,W=8,R=6.5,S=7.5 If yoU took OET Test, enter result as : OET :W=300,S=350,L=400,R=380
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9
Please, upload your NMBI Decision letter here. If you are awaiting NMBI decision letter, upload your IELTS/OET Test result
*
This field is required.
Please, Upload your NMBI decision letter. if you are awaiting your decision letter, upload your IELTS/OET Document here
Drag and drop files here
Select files to upload
Max. file size
: 10.0MB
Upload a File
File should be in jpg or pdf format
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10
Academic Institution Where You Obtained Your Nursing Qualification
*
This field is required.
Academic Institution's Name
please, enter the academic institutions name here
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11
Year Your Qualification Was Obtained
*
This field is required.
Enter the Year You Qualified.
Example: 2020
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12
Nursing PIN Number
*
This field is required.
Please,Enter your nursing practice number here
e.g. 11183021
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13
Nursing Qualification
*
This field is required.
Please, select from the drop down menu
Please,Scroll and Select
Diploma in Nursing
BSC in Nursing
Masters In Nursing
None
Please Select
Please,Scroll and Select
Diploma in Nursing
BSC in Nursing
Masters In Nursing
None
for Incoming A.Y. '12-'13
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14
Please,State Other Nursing Qualification You Have.If no other, Enter N/A
*
This field is required.
Other nursing qualifications
Enter the info here
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15
Nursing Qualification: eg Diploma/Degree Certificate
*
This field is required.
Please, upload your qualification certificate here
Drag and drop files here
Select files to upload
Max. file size
: 10.0MB
Upload a File
File should be in jpg format
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16
Name & Address Of Current Employer
*
This field is required.
Where do you currently work?
Enter the name and address of current employer here
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17
Title of Your Job Role.eg Staff Nurse
*
This field is required.
Example: Clinical Nurse Manager
please, enter your job position here
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18
How long Have You Been In This Current Employment?:
*
This field is required.
Please, enter the number of years you have worked here
Enter the number of Years Here
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19
What Is Your Current Annual Salary?:
*
This field is required.
How much do you currently earn in your local currency? This is for survey purposes. It does not affect the salary the employer will offer you as you will be paid according to Irish guidelines.
Enter Your Annual Salary Per Annum Here
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20
Curriculum Vitae (Upload Your CV)
*
This field is required.
Include all affiliations, leadership positions, awards received (and award giving body), work experience during your entire high school to college and after graduation.
Drag and drop files here
Select files to upload
Max. file size
: 10.0MB
Upload a File
File should be in pdf, doc/docx format.
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21
Which Branch of Nursing Are You Specialised In?
*
This field is required.
Please, select the applicable boxes if you have dual specialty
Midwifery
Children Nursing
General Nursing
Intellectual Disability nursing
Psychiatric Nursing
Other
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22
Other Specialist Training
Any other relevant nursing training
Other Nursing Related Training
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23
Skills & Competency (Part 1)
*
This field is required.
Please, select all the applicable boxes
A & E
ICU (Paeds)
Burns & Plastic
Medical
Cardio Thoracic
Midwifery
CCI
Neonates
Computer Skills
Nephrology
ENT
Neurosurgery
Geriatric
Obstetrics/Gynae
ICU (Adults)
Occu Health
None
Other
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24
Skills & Competency (Part 2)
*
This field is required.
Please, select all applicable boxes
Oncology
Surgical
Orthopaedics
Theatre/OR
Paediatrics
Diabetic Care
Phlebotomy
Dermatology
Psychiatry
Chemotherapy
Renal
Gastroenterology
Special Care (Babies)
Tracheostomy
None
Other
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25
Marital Status
*
This field is required.
Please, tick one box only
Single
Married
Living With Partner
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26
How Many Children Do You Have?
*
This field is required.
Please, select one box only
None
Three Children
One Child
Four Children
Two Children
4+ Children
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27
Do You Plan To Migrate To Ireland With Your Family?
*
This field is required.
Please, select one box only
Yes
No
Not Sure
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28
Migrating To Ireland Require Some Upfront Expenses, eg : IELTS/OET Test Fees, NMBI Registration Fees, Employment Permit Fees,Visa Fees, Flight Ticket,& Accommodation. Do You Have The Resources To Cover These Upfront Expenses?
*
This field is required.
Please, select the applicable box
Yes
No
Not Sure
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29
How Much Resources Do You Have Available To Cover Some Upfront Expenses, eg : IELTS/OET Test Fees, NMBI Registration Fees, Employment Permit Fees,Visa Fees, Flight Ticket,& Accommodation?
*
This field is required.
Please, select the applicable box. It will not be useful of our resources to find you a job in Ireland only to find out that you are unable to fund your migration trip.
€1500
€2500
€3500
€4500
€5500
None
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30
If You Are Offered A Job In Ireland Today,What Is Your Salary Expectation Per Annum?
*
This field is required.
Please, select an applicable option
Please, scroll and select
€32,000- €36,000 P/A
€37,000- €40,000 P/A
€41,000- €45,000 P/A
€45,000- €50,000 P/A
€50,000 and above
Please, scroll and select
Please, scroll and select
€32,000- €36,000 P/A
€37,000- €40,000 P/A
€41,000- €45,000 P/A
€45,000- €50,000 P/A
€50,000 and above
Select one option only
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31
Additional Information
Please, add any additional information that may be relevant to help your application.
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32
I am Human
*
This field is required.
Only tick the box if you are a human being
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Oversea Nurses Registration Form
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