Nurse HCEP & P Candidate Application Form

Location: ., .
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Days
Evenings
Nights
Weekends

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Make sure the lower end of the range is a salary you are comfortable with

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Days
Evenings
Nights
Weekends

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Director, ER nurse, nurse practitioner, etc

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UNKNOWN
N/A
ALL STATES
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
GU
PR

 
If willing to relocate, then specify the reason(s) of relocation

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Enter miles in number only ex. 45

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How many weeks needed for notice, relocation and other reason(s) before being able to start

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Current (Active)
Pending
Not Yet Applied

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Explain the thought process in your transition from one position to the next (mention your last 3 positions only and if it was a career advancement, layoff, relocation, etc.)

 
Please provide any other information pertaining to this application

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U.S. Citizen
Permanent Resident (Green Card)
TN-1 VISA (Canadian and Mexican)
H1-B VISA
J-1 VISA
O-1 VISA
EAD
Canadian Citizen
Other