Kennedy Healthcare Recruiting, Inc.

If you are a registered nurse currently residing in the US on a temporary visa, we may be able to obtain a green card for you, without you having to leave the country. 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!

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 for your application!

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

US VISA
Type of visa:
Date of Entry:
Date of Expiration:

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

Date Taken:		/
Place Taken:

NCLEX

Date Taken:		/
Place Taken:

IELTS

Date Taken:

TOEFL

Date Taken:

TSE

Date Taken:

TWE

Date Taken: