Employment Application Form
 

 

URGENT NOTICE – PLEASE NOTE UNTIL THE NOV. 2006 Retrogression Law is Lifted GNI CANNOT PLACE FOREIGN NURSES IN THE U.S. This does not apply to Canadian or Mexican nurses.
All questions with an * must be completed in order to submit application.
 
*First Name: Middle Initial: *Last Name:
   
 
*Current Phone Number (With City and Country Codes):
 
Best time to reach:
   
 
Mobile Phone Number (With City and Country Codes):
 
Best time to reach:
   
 
Work Phone Number (With City and Country Codes):
   
 
*Street Address:
 
*City: State: Country:
   
 
*Email Address:
   
 
Date available for employment (MM/DD/YYYY):
   
 
Please check which countries you are seeking employment
(please note all overseas positions, not U.S., are a minimum of 1 year):
U.S. Australia Dubai
Canada New Zealand United Arab Emirates
U.K. Southern Ireland Saudi Arabia
   
  Interested in (please check one):
 
Permanent 13 weeks 26 weeks 12 months 18 months 24 months 36 months
   
  Nursing Experience (You can check more than one specialty):
 
Med/Surg. PICU Post Partum NICU SDS ACU
OR/Rec ICU/CCU Burn ICU CVICU Endo/GI CRNA
ER Psych Tele/DOU Cardiac Cath Neuro Stepdown
Oncology Rehab MICU PACU Neuro ICU    
Pediatrics L&D SICU MB PCU Other
   
  Ancillary Positions (please check one):
 
LPN/LVN Surgical Tech MRI/CT Tech
PT/OT Pharmacist Other
   
 
Do you have management experience ? Yes No
   
 
Country of Birth:
   
 
Citizenship:
   
 
Do you have US Resident/ Alien Status? Yes No
   
 
Do you have your CGFNS Certificate? Yes No
 
If no, when do you plan to sit for exam? (MM/DD/YYYY):
 
Do you have your NCLEX Certificate? Yes No
 
If no, when do you plan to sit for exam? (MM/DD/YYYY):
   
  Language certification (If you studied nursing in English then this is not a requirement)
   
 
Did you take the Test of English as a Second Language (TOEFL) exam? Yes No Test Score:
   
 
Did you take the MELAB exam? Yes No Test Score:
   
 
Did you take the IELTS exam? Yes No Test Score:
   
 
How did you hear about GNI?
   
  If you were referred to GNI, please enter the name of the person:
 
First Name: Last Name:
   
  If you have been in contact with a GNI Recruiter or Affiliate Office Recruiter, please enter his/her name:
 
First Name: Last Name:
   
 
Nursing License #:
   
 
Licensing State or Country:
   
 
Other Licenses:
 
Has your license ever been suspended or revoked? : Yes No
 
Have you ever been convicted of a misdemeanor or felony? : Yes No
   
 
Education/ Degrees:
   
 
Advanced Degrees:
   
 
Are you presently working for a Traveling Nurse Agency?: Yes No
   
 
Present Hourly Compensation in US Dollars:
   
 
Resume: Please attach Resume or Curriculum Vitae, if you have it, to this application form.
If you have problems attaching your resume to the application, please submit your application without your resume and email your resume to hr@global-nurses.com.
 
 

  3455 Peachtree Rd NE 5th Floor Atlanta, GA 30326-3254 Phone: 404-474-2755 Fax: 484.208.4471 www.global-nurses.com