Application Form About YouSurname* First Name* Primary Phone Number* Mobile Phone Number (If different from Primary Number above) Email Address* Your ResumeMax. file size: 128 MB.Skype ID Current Country LocationPlease SelectUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia; Plurinational StateBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChannel IslandsChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo; Democratic Republic ofCongo; Republic ofCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran; Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea; Democratic People's Republic Of (North)Korea; Republic Of (South)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMacedonia; the Former Yugoslav RepublicMadagascarMalawiMalaysiaMaldives; Republic ofMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia; Federated States ofMoldova; Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory; OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena; Ascension and Tristan Da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre And MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela; Bolivarian Republic ofVietnamVirgin Islands; BritishVirgin Islands; U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsEducationEducation LevelPlease SelectBSNMSNANDDIPCountry of EducationPlease SelectUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia; Plurinational StateBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChannel IslandsChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo; Democratic Republic ofCongo; Republic ofCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran; Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea; Democratic People's Republic Of (North)Korea; Republic Of (South)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMacedonia; the Former Yugoslav RepublicMadagascarMalawiMalaysiaMaldives; Republic ofMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia; Federated States ofMoldova; Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory; OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena; Ascension and Tristan Da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre And MiquelonSaint Vincent and GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela; Bolivarian Republic ofVietnamVirgin Islands; BritishVirgin Islands; U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsEmploymentCurrent Specialty*Please SelectMed/SurgTelemetry/Step Down UnitICUERPediatricsPICUNICULabor & DeliveryObs/GynaePACU/Recovery RoomOROncologyDialysisMental HealthRehabCare of the ElderlyUnemployed at Time of ApplicationAdministrative (non-clinical) at Time of ApplicationNew GradCCUOtherOther Specialty Number of Years Within This Specialty*Please Select12345678910+15+Other Specialty (if Different From Current Specialty and within last 5 years)Please SelectMed/SurgTelemetry/Step Down UnitICUERPediatricsPICUNICULabor & DeliveryObs/GynaePACU/Recovery RoomOROncologyDialysisMental HealthRehabCare of the ElderlyUnemployed at Time of ApplicationAdministrative (non-clinical) at Time of ApplicationNew GradCCUOtherOther Specialty Number of Years Within This SpecialtyPlease Select12345678910+15+ NCLEX and Licensing InformationHave you Passed NCLEX?* Yes No Would you like details of NCLEX Assistance Program? Yes No Did you Pass NCLEX with CareerKnacks NCLEX Assistance Program? Yes No What is the Status of your Original NCLEX Board of Nursing License?Please SelectActiveInactiveExpiredNCLEX pass only (no license obtained)Expiry date of your Original NCLEX Board of Nursing License (mm/yyyy) Do You Have a NCLEX Candidate Bulletin Report Available? (the passing letter with your photo on it provided by your NCLEX state) Yes No What State Board did you pass NCLEX with?Please SelectALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNMINYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDo You Hold Any Other USA Licenses?Please SelectALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNMINYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDo You Hold Any Other USA Licenses?Please SelectALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNMINYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDo You Hold Any Other USA Licenses?Please SelectALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNMINYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYOther CredentialsDo You Have a VisaScreen Certificate?*Please SelectYesNoPending (already applied)Please Provide VisaScreen Certificate Expiry Date (mm/yyyy) Have You Passed IELTS?Please SelectYesNoPending (already applied)Please Provide IELTS Expiry Date (mm/yyyy) Do You Have a US Social Security Number? Yes No Do You Have an ITIN Number? Yes No Do you possess a current or cancelled EB3 (greencard petition)? Yes No Please Provide Your Priority Date MM slash DD slash YYYY Where Did You Hear About CareerKnacks?Please SelectWebsiteSocial MediaSearch EngineReferred by Friend Not Yet Employed in USAReferred by Friend Already Employed in USAAgentYour friend's name Agent name Privacy Agreement and agree to the Terms and Conditions* I have read and agree to the Privacy Agreement and Terms and Conditions as detailed within the CareerKnacks website Contact confirmation* By submitting this application I am giving my agreement for CareerKnacks to contact me by email or telephone regarding my application and to periodically contact me with updates regarding USA employment and sponsorship opportunities that may be relevant to me.