City

State

Country of Birth: *

Married or Single: *

Male or Female

No. of Children or None: *

USA Visa: (Asylum, B1, TPS, F1), H1-4), etc.

CGFNS Certifications i.e. CES, Visa Screen, IELTS

Work Permit (OPT, EAD) and Exp . Date

NCLEX: passed, applied for, what state ?

Best Days/Call Time for Interview (CST)

Education: USA BSN, ADN or other country degree

Company / Website or Person who Referred You

List US State / City Work Preferences: *

Any immigration issues you may wish to discuss

Est. Date Available for Work: *

RN Licensure or NCLEX Attachment

EAD or OPT Attachment