APPLICATION FOR REGISTERED NURSE - AAWMCSI | Manpower & Consultancy Services Inc.

Respond to all questions. If a question does not apply to you, use "N/A" to indicate that it is not applicable.

APPLICATION FORM:

Personal Information

REFERENCE CODE:

Last Name

First Name

Middle Name

Maiden Name

Citizenship

Date of Birth

Gender

Marital Status

Postal | Zip

Spouse

General Information

Spouse Last Name

Spouse First Name

Spouse Middle Name

Spouse Citizenship

Spouse Occupation

Spouse Date of Birth

Do you have Children?

Yes

Children

General Information

Children's Last Name

Children's First Name

Children's Middle Name

Children's Age

Children's Date of Birth

Children's Place of Birth

Address

General Information

Present Address:

State | Province

City

Country

Home Phone

Mobile Phone

Email Address

Mandatory Communication Requirements

Please be advised that if the information below is not provided, we will not be able to accept your application.

SOCIAL MEDIA PLAYS A VERY IMPORTANT PART OF OUR COMMUNICATION EFFORTS IN CONTACTING YOU. IF YOU DO NOT HAVE A WHATSAPP AND/OR FACEBOOK MESSENGER YOU MUST MAKE ONE AND LIST YOUR ACCOUNT NAME BELOW.

Facebook Messenger

PLEASE BE DETAILED AS POSSIBLE IN QUESTIONS, EDUCATION AND EMPLOYMENT HISTORY

EDUCATION:

(Please list the Two Institutions you have attended)

1. Name of Institution

Month | Year Ended

Name of Diploma | Certificate

2. Name of Institution

Month | Year Ended

Name of Diploma | Certificate

EMPLOTMENT HISTORY:

(Please list your last Three Employers, starting with the most recent one)

1. Name of Employer

Address

Mobile Phone

Position

Country

Employed From

Employed To

Job Description

2. Name of Employer

Address

Mobile Phone

Position

Country

Employed From

Employed To

Position

Country

Employed From

Employed To

GENERAL INFORMATION | FOR REGISTERED NURSES

(Please fill out your details information)

What Language do you speak?

English

French

Other

if "other" please specify:

Have you taken NCLEX

Yes

Choose File

Do you have a valid driver's license?

Yes

if "Yes", placed issued:

if "Yes", date issued:

If you don't have a license, would you be willing to learn drive in USA?

Yes

Person to be contacted in case of emrgency

(Please fill out your details information)

Name

Phone | Mobile

Address

File Upload (RESUME | CV) PDF File only with your photo.

Choose File

NOTE: This Offline Payment Registration is for Evaluation. Please send proof of payment via Email to complete the registration (Email us: billing@aawmcs.com)

Pay with PayPal | Payment Amount

Price: $150.00