CANDIDATE REGISTRATION & APPLICATION FORM
Basic Information
First Name
Last Name
Email
Mobile Phone
Country of Birth
Select Country
How did you hear about us?
Select
Facebook
Instagram
Google
Friend
Gender
Select
Male
Female
Date of Birth
RN Information
Are you a Registered Nurse?
Select
Yes
No
RN License Status
Select
Active
Waiting for renewal
Expired
Do you currently work in an acute care inpatient hospital with 100+ beds?
Select an option
Yes
No
Unemployed
Employment Type
Select
Full Time
Part Time
Locum
NCLEX Status
Select
Not Taken
Scheduled
Passed
Failed
Have you ever applied for any type of US Visa in the past?
Or has anyone applied on your behalf?
Select an option
Yes
No
Education
University / Nursing Board Name
Degree Type
Select degree
Diploma
Generic BSN
Post RN BSN
MSN
Graduation Date
RN License First Issue Date
Employment
What is the name of your current hospital?
In which city is your hospital located?
Country
Please provide the link to your hospital's official website.
This is used to confirm your hospital's official bed count. If you are unable, please leave this field blank.
Specialty / Unit
Have you ever signed a contract with another US RN staffing agency?
Select
Yes
No
Family & Preferences
Marital Status
Select
Single
Married
Divorce
Widow
Upload Documents
Upload CV
Please upload in PDF or Word (.docx) format. Your CV must be updated, include your current hospital/employer, and job dates (MM/YYYY). Do not upload screenshots.
RN License / PIN
Upload front & back copy of your RN license with visible expiration date.
Front Side
Back Side
Passport Size Picture
English Language Screening (1-minute video)
Please answer:
• Advice for nursing students
• Where would you like to work in the US and why?
• What inspired you to become a nurse?
Submit Application