Kennedy Healthcare Recruiting, Inc.

If you are a registered nurse holding a nursing school diploma, and a valid nursing license, we invite you to apply to KHR! Please complete the form below so that we may know more about your situation. Be sure to provide us with an email and a phone number where we can reach you. We will respond to your query as soon as we receive your application. Thank you, in advance for your interest in Kennedy!

NOTE: If you are a registered nurse currently residing in the US, and would like for us to help you obtain permanent residence without having to leave the country, please fill out the application located here.

Please fill out the information below. Fields in red are required. Some of these fields may not be applicable to you, depending upon your education, experience, and work preferences. Thank you!

BASIC INFORMATION
Last Name
First Name
Middle Initial
Email
Phone (Please provide a land line)
Cell Phone
Best time to call
Street
City/Town/Village
State
Zip
Country
Sex
Birthdate (Month/Day/Year):
Country of Birth
Marital Status
Number of Children

BEEN TO THE US?
Where in the US d o you have friends or relatives?

Have you ever been to the US?

Yes No

Have you ever been denied a US Visa?

Yes No

YOUR EDUCATION
Nursing School Attended:
Nursing School City/State/Country:
Year Graduated:
Number of years attended:
Degree Obtained:
Number of Years Experience Post Degree:
List any additional degrees:
Do you have any certifications, specializations, or supervisory experience? Please describe.

YOUR EXPERIENCE
Please list your employment history, starting with your most recent.
Employer
City:
Country
Dates		/ until /
Position
Duties Performed

Employer
City:
Country
Dates		/ until /
Position
Duties Performed

Employer
City:
Country
Dates		/ until /
Position
Duties Performed

Employer
City:
Country
Dates		/ until /
Position
Duties Performed

Employer
City:
Country
Dates		/ until /
Position
Duties Performed

YOUR CREDENTIALS

Have you taken any of these exams?

CGFNS

NCLEX

IELTS

TOEFL

TSE

TWE

Have you applied for a VisaScreen?

Yes No

YOUR PREFERENCES
Please let us know if you have any specific requirements for where you want to work in the US, and the resons for your preference.
I prefer the following location:
Reason:

HOW DID YOU FIND US?
How did you hear about us?
Additional Details

The contents of these pages are provided for general information purposes only and do not constitute legal advice. KHR is not a law firm and does not provide immigration or other legal advice. You should speak with an experienced attorney about all immigration issues. KHR can arrange a free consultation with an experienced immigration attorney.

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Kennedy Healthcare Recruiting, Inc. 16 Center St. Northampton, MA 01060
info@kennedyhealthcare.com | (413) 517-0063 (P) | (413) 517-0057 (F)