Employment Application
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Required field
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First Name:
*
Last Name:
*
Email Address:
*
Current Phone Number:
Are you a RN / RGN?
Yes
No
Do you have a current U.S. Nursing License?
Yes
No
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
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Which state?
*
Have you passed the NCLEX?
Yes
No
Do you have CGFNS Certification?
Yes
No
Have you passed SBTPE?
Yes
No
Date:
Score:
Have you passed CNATS?
Yes
No
Date:
Score:
*
Do you have 12 months of Post Graduate experience?
Yes
No
Do you require Green Card sponsorship for:
Yourself
Your spouse and family members under 21yrs.
When would you be available? Date:
Which state would you like to work in?
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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