nurses.visasolutionshealthcare.com
Open in
urlscan Pro
107.178.254.45
Public Scan
URL:
https://nurses.visasolutionshealthcare.com/
Submission: On July 27 via automatic, source rescanner — Scanned from DE
Submission: On July 27 via automatic, source rescanner — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://visasolutions.formstack.com/forms/index.php
<form method="post" accept-charset="UTF-8" novalidate="" enctype="multipart/form-data" action="https://visasolutions.formstack.com/forms/index.php" class="fsForm fsMultiColumn" id="fsForm4884614">
<input type="hidden" name="form" value="4884614">
<input type="hidden" name="viewkey" value="Ou71mcVQ5C">
<input type="hidden" name="password" value="">
<input type="hidden" name="hidden_fields" id="hidden_fields4884614" value="">
<input type="hidden" name="incomplete" id="incomplete4884614" value="">
<input type="hidden" name="incomplete_password" id="incomplete_password4884614">
<input type="hidden" name="referrer" id="referrer4884614" value="https://nurses.visasolutionshealthcare.com/">
<input type="hidden" name="referrer_type" id="referrer_type4884614" value="js">
<input type="hidden" name="_submit" value="1">
<input type="hidden" name="style_version" value="3">
<input type="hidden" id="viewparam" name="viewparam" value="858630">
<div id="requiredFieldsError" style="display:none;">Please fill in a valid value for all required fields</div>
<div id="invalidFormatError" style="display:none;">Please ensure all values are in a proper format.</div>
<div id="resumeConfirm" style="display:none;">Are you sure you want to leave this form and resume later?</div>
<div id="resumeConfirmPassword" style="display: none;">Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.</div>
<div id="saveAndResume" style="display: none;">Save and Resume Later</div>
<div id="saveResumeProcess" style="display: none;">Save and get link</div>
<div id="fileTypeAlert" style="display:none;">You must upload one of the following file types for the selected field:</div>
<div id="embedError" style="display:none;">There was an error displaying the form. Please copy and paste the embed code again.</div>
<div id="applyDiscountButton" style="display:none;">Apply Discount</div>
<div id="dcmYouSaved" style="display:none;">You saved</div>
<div id="dcmWithCode" style="display:none;">with code</div>
<div id="submitButtonText" style="display:none;">Submit</div>
<div id="submittingText" style="display:none;">Submitting</div>
<div id="validatingText" style="display:none;">Validating</div>
<div id="autocaptureDisabledText" style="display:none;"></div>
<div id="paymentInitError" style="display:none;">There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.</div>
<div id="checkFieldPrompt" style="display:none;">Please check the field: </div>
<div id="translatedWord-fields" style="display:none;">Fields</div>
<div class="fsPage" id="fsPage4884614-1">
<div id="ReactContainer4884614" style="display:none" class="FsReactContainerInitApp" data-fs-react-app-id="4884614"></div>
<div class="fsSection fs2Col" id="fsSection127862688">
<div class="fsSectionHeader">
</div>
<div id="fsRow4884614-2" class="fsRow fsFieldRow fsLastRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100" id="fsCell127862689" lang="en" fs-field-type="richtext" fs-field-validation-name="">
<p><span style="color: rgb(40, 50, 78);"><strong><span style="font-family: Tahoma,Geneva,sans-serif;"><u>General Information </u></span></strong></span></p>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-3" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862690" lang="en" fs-field-type="text" fs-field-validation-name="Name">
<label id="label127862690" class="fsLabel fsRequiredLabel" for="field127862690">Name<span class="fsRequiredMarker">*</span> </label>
<input type="text" id="field127862690" name="field127862690" size="50" required="" value="" class="fsField fsFormatText fsRequired " aria-required="true">
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50" id="fsCell127862691" lang="en" fs-field-type="text" fs-field-validation-name="Last Name">
<label id="label127862691" class="fsLabel fsRequiredLabel" for="field127862691">Last Name<span class="fsRequiredMarker">*</span> </label>
<input type="text" id="field127862691" name="field127862691" size="50" required="" value="" class="fsField fsFormatText fsRequired " aria-required="true">
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-4" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862692" lang="en" fs-field-type="text" fs-field-validation-name="Phone Number">
<label id="label127862692" class="fsLabel fsRequiredLabel" for="field127862692">Phone Number<span class="fsRequiredMarker">*</span> </label>
<input type="text" id="field127862692" name="field127862692" size="50" required="" placeholder="example: + Country Code - Area Code - Local Number" title="example: + Country Code - Area Code - Local Number" value=""
class="fsField fsFormatText fsRequired " aria-required="true">
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50" id="fsCell127862693" lang="en" fs-field-type="email" fs-field-validation-name="Email">
<label id="label127862693" class="fsLabel fsRequiredLabel" for="field127862693">Email<span class="fsRequiredMarker">*</span> </label>
<input type="email" id="field127862693" name="field127862693" size="50" required="required" value="" class="fsField fsFormatEmail fsRequired" aria-required="true">
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-5" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862694" lang="en" fs-field-type="select" fs-field-validation-name="Country of Citizenship">
<label id="label127862694" class="fsLabel fsRequiredLabel" for="field127862694">Country of Citizenship<span class="fsRequiredMarker">*</span> </label>
<select id="field127862694" name="field127862694" size="1" required="" class="fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua And Barbuda">Antigua And Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius And Saba">Bonaire, Sint Eustatius And Saba</option>
<option value="Bosnia And Herzegovina">Bosnia And Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="The Democratic Republic Of The Congo">The Democratic Republic Of The Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote d'Ivoire">Cote d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Eswatini">Eswatini</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island And Mcdonald Islands">Heard Island And Mcdonald Islands</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle Of Man">Isle Of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Republic Of Korea">Republic Of Korea</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="The Former Yugoslav Republic Of Macedonia">The Former Yugoslav Republic Of Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Federated States Of Micronesia">Federated States Of Micronesia</option>
<option value="Republic Of Moldova">Republic Of Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension And Tristan Da Cunha">Saint Helena, Ascension And Tristan Da Cunha</option>
<option value="Saint Kitts And Nevis">Saint Kitts And Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French Part)">Saint Martin (French Part)</option>
<option value="Saint Pierre And Miquelon">Saint Pierre And Miquelon</option>
<option value="Saint Vincent And The Grenadines">Saint Vincent And The Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome And Principe">Sao Tome And Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch Part)">Sint Maarten (Dutch Part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia And The South Sandwich Islands">South Georgia And The South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard And Jan Mayen">Svalbard And Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad And Tobago">Trinidad And Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks And Caicos Islands">Turks And Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States 🇺🇸">United States 🇺🇸</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City State">Vatican City State</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis And Futuna">Wallis And Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50" id="fsCell127862695" lang="en" fs-field-type="select" fs-field-validation-name="Country of Residence">
<label id="label127862695" class="fsLabel fsRequiredLabel" for="field127862695">Country of Residence<span class="fsRequiredMarker">*</span> </label>
<select id="field127862695" name="field127862695" size="1" required="" class="fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua And Barbuda">Antigua And Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius And Saba">Bonaire, Sint Eustatius And Saba</option>
<option value="Bosnia And Herzegovina">Bosnia And Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="The Democratic Republic Of The Congo">The Democratic Republic Of The Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote d'Ivoire">Cote d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Eswatini">Eswatini</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island And Mcdonald Islands">Heard Island And Mcdonald Islands</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle Of Man">Isle Of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Republic Of Korea">Republic Of Korea</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="The Former Yugoslav Republic Of Macedonia">The Former Yugoslav Republic Of Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Federated States Of Micronesia">Federated States Of Micronesia</option>
<option value="Republic Of Moldova">Republic Of Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension And Tristan Da Cunha">Saint Helena, Ascension And Tristan Da Cunha</option>
<option value="Saint Kitts And Nevis">Saint Kitts And Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French Part)">Saint Martin (French Part)</option>
<option value="Saint Pierre And Miquelon">Saint Pierre And Miquelon</option>
<option value="Saint Vincent And The Grenadines">Saint Vincent And The Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome And Principe">Sao Tome And Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch Part)">Sint Maarten (Dutch Part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia And The South Sandwich Islands">South Georgia And The South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard And Jan Mayen">Svalbard And Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad And Tobago">Trinidad And Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks And Caicos Islands">Turks And Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States 🇺🇸">United States 🇺🇸</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City State">Vatican City State</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis And Futuna">Wallis And Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-6" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862696" lang="en" fs-field-type="select" fs-field-validation-name="How did you find out about this opportunity?">
<label id="label127862696" class="fsLabel fsRequiredLabel" for="field127862696">How did you find out about this opportunity?<span class="fsRequiredMarker">*</span> </label>
<select id="field127862696" name="field127862696" size="1" required="" class="fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="Online search">Online search</option>
<option value="Facebook">Facebook</option>
<option value="YouTube">YouTube</option>
<option value="Family/Friend">Family/Friend</option>
<option value="Event">Event</option>
<option value="Instagram">Instagram</option>
<option value="LinkedIn">LinkedIn</option>
<option value="Other">Other</option>
</select>
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsHidden fsSpan50" id="fsCell127862697" lang="en" fs-field-type="text" fs-field-validation-name="What type of visa are you currently on? ">
<label id="label127862697" class="fsLabel fsRequiredLabel" for="field127862697">What type of visa are you currently on? <span class="fsRequiredMarker">*</span> </label>
<input type="text" id="field127862697" name="field127862697" size="50" required="" value="" class="fsField fsFormatText fsRequired " aria-required="true" disabled="disabled">
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-7" class="fsRow fsFieldRow fsLastRow fsHidden">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsHidden fsSpan50" id="fsCell127862698" lang="en" fs-field-type="name" fs-field-validation-name="Person who referred you (Referral Program):">
<span id="label127862698" class="fsLabel">Person who referred you (Referral Program):</span>
<div class="fsSubFieldGroup">
<div class="fsSubField fsNameFirst">
<input type="text" id="field127862698-first" name="field127862698-first" size="20" aria-label="First Name" value="" class="fsField fsFieldName" disabled="disabled">
<label class="fsSupporting" for="field127862698-first">First Name</label>
</div>
<div class="fsSubField fsNameLast">
<input type="text" id="field127862698-last" name="field127862698-last" size="20" aria-label="Last Name" value="" class="fsField fsFieldName" disabled="disabled">
<label class="fsSupporting" for="field127862698-last">Last Name</label>
</div>
</div>
<div class="clear"></div>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-8" class="fsRow fsFieldRow fsLastRow fsHidden">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsHidden fsSpan100" id="fsCell127862699" lang="en" fs-field-type="richtext" fs-field-validation-name="">
<p style="text-align: center;"><img src="https://s3.amazonaws.com/files.formstack.com/public/858630/image_exclamationmark1.png" style="width: 21px; height: 21px;" class="fr-fic fr-dib"></p>
<p style="text-align: center;"><span style="color: rgb(184, 49, 47);"><strong>Sorry! Unfortunately at this moment we are not processing cases from your country. </strong></span></p>
<p style="text-align: center;"><br></p>
<p style="text-align: center;"><br></p>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-9" class="fsRow fsFieldRow fsLastRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100" id="fsCell127862700" lang="en" fs-field-type="richtext" fs-field-validation-name="">
<p><span style="color: rgb(40, 50, 78);"><strong><u>Experience</u></strong></span></p>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-10" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862701" lang="en" fs-field-type="checkbox" fs-field-validation-name="Are you currently working clinically? ">
<fieldset role="group" aria-labelledby="fsLegend127862701" id="label127862701">
<legend id="fsLegend127862701" class="fsLabel fsRequiredLabel fsLabelVertical"><span>Are you currently working clinically? <span class="fsRequiredMarker">*</span></span></legend>
<div class="fieldset-content">
<label class="fsOptionLabel vertical" for="field127862701_1"><input type="checkbox" id="field127862701_1" name="field127862701[]" value="Yes" class="fsField fsRequired vertical" aria-required="true">Yes</label>
<label class="fsOptionLabel vertical" for="field127862701_2"><input type="checkbox" id="field127862701_2" name="field127862701[]" value="No" class="fsField fsRequired vertical" aria-required="true">No</label>
</div>
</fieldset>
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50" id="fsCell127862702" lang="en" fs-field-type="select" fs-field-validation-name="What is your specialty? ">
<label id="label127862702" class="fsLabel" for="field127862702">What is your specialty? </label>
<select id="field127862702" name="field127862702" size="1" class="fsField">
<option value=""> </option>
<option value="Critical Care">Critical Care</option>
<option value="ER">ER</option>
<option value="ICU">ICU</option>
<option value="Labor & Delivery">Labor & Delivery</option>
<option value="Med Surge">Med Surge</option>
<option value="NICU">NICU</option>
<option value="OR">OR</option>
<option value="Pediatric">Pediatric</option>
<option value="PICU">PICU</option>
<option value="Telemetry">Telemetry</option>
<option value="Other">Other</option>
</select>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-11" class="fsRow fsFieldRow fsLastRow fsHidden">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsHidden fsSpan50" id="fsCell127862703" lang="en" fs-field-type="text" fs-field-validation-name="Employer's name ">
<label id="label127862703" class="fsLabel" for="field127862703">Employer's name </label>
<input type="text" id="field127862703" name="field127862703" size="50" value="" class="fsField fsFormatText " disabled="disabled">
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-12" class="fsRow fsFieldRow fsLastRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100" id="fsCell127862704" lang="en" fs-field-type="richtext" fs-field-validation-name="">
<p><span style="color: rgb(40, 50, 78);"><strong><u>Education</u></strong></span></p>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-13" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862705" lang="en" fs-field-type="select" fs-field-validation-name="Education">
<label id="label127862705" class="fsLabel fsRequiredLabel" for="field127862705">Education<span class="fsRequiredMarker">*</span> </label>
<select id="field127862705" name="field127862705" size="1" required="" class="fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="Bachelor's Degree">Bachelor's Degree</option>
<option value="Diploma">Diploma</option>
<option value="Registered Nurse">Registered Nurse</option>
<option value="Registered Midwife">Registered Midwife</option>
<option value="Registered Mental Health Nurse">Registered Mental Health Nurse</option>
<option value="Certificate">Certificate</option>
<option value="Associate's Degree">Associate's Degree</option>
<option value="Master's Degree">Master's Degree</option>
<option value="Doctoral Degree">Doctoral Degree</option>
</select>
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50" id="fsCell127862706" lang="en" fs-field-type="select" fs-field-validation-name="Country of Education">
<label id="label127862706" class="fsLabel fsRequiredLabel" for="field127862706">Country of Education<span class="fsRequiredMarker">*</span> </label>
<select id="field127862706" name="field127862706" size="1" required="" class="fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua And Barbuda">Antigua And Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire, Sint Eustatius And Saba">Bonaire, Sint Eustatius And Saba</option>
<option value="Bosnia And Herzegovina">Bosnia And Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="The Democratic Republic Of The Congo">The Democratic Republic Of The Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote d'Ivoire">Cote d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island And Mcdonald Islands">Heard Island And Mcdonald Islands</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle Of Man">Isle Of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Republic Of Korea">Republic Of Korea</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="The Former Yugoslav Republic Of Macedonia">The Former Yugoslav Republic Of Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Federated States Of Micronesia">Federated States Of Micronesia</option>
<option value="Republic Of Moldova">Republic Of Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena, Ascension And Tristan Da Cunha">Saint Helena, Ascension And Tristan Da Cunha</option>
<option value="Saint Kitts And Nevis">Saint Kitts And Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French Part)">Saint Martin (French Part)</option>
<option value="Saint Pierre And Miquelon">Saint Pierre And Miquelon</option>
<option value="Saint Vincent And The Grenadines">Saint Vincent And The Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome And Principe">Sao Tome And Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch Part)">Sint Maarten (Dutch Part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia And The South Sandwich Islands">South Georgia And The South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard And Jan Mayen">Svalbard And Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad And Tobago">Trinidad And Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks And Caicos Islands">Turks And Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States 🇺🇸">United States 🇺🇸</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City State">Vatican City State</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis And Futuna">Wallis And Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-14" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862707" lang="en" fs-field-type="text" fs-field-validation-name="College/ University Name">
<label id="label127862707" class="fsLabel fsRequiredLabel" for="field127862707">College/ University Name<span class="fsRequiredMarker">*</span> </label>
<input type="text" id="field127862707" name="field127862707" size="50" required="" value="" class="fsField fsFormatText fsRequired " aria-required="true">
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50" id="fsCell127862708" lang="en" fs-field-type="datetime" fs-field-validation-name="Graduation Date">
<fieldset role="group" aria-labelledby="fsLegend127862708" id="label127862708">
<legend id="fsLegend127862708" class="fsLabel fsRequiredLabel fsLabelVertical"><span>Graduation Date<span class="fsRequiredMarker">*</span></span></legend>
<div class="fieldset-content">
<!-- Used to pull in url for jquery -->
<span aria-hidden="true" style="display:none;" id="fsCalendar127862708ImageUrl">https://visasolutions.formstack.com/forms/images/2/calendar.png</span>
<input data-skip-validation="" data-date-format="M d, Y" type="hidden" id="field127862708Format" name="field127862708Format" value="MDY">
<div class="hidden"><label for="field127862708M">Month</label></div>
<select id="field127862708M" name="field127862708M" class=" fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="Jan">Jan</option>
<option value="Feb">Feb</option>
<option value="Mar">Mar</option>
<option value="Apr">Apr</option>
<option value="May">May</option>
<option value="Jun">Jun</option>
<option value="Jul">Jul</option>
<option value="Aug">Aug</option>
<option value="Sep">Sep</option>
<option value="Oct">Oct</option>
<option value="Nov">Nov</option>
<option value="Dec">Dec</option>
</select>
<div class="hidden"><label for="field127862708D">Day</label></div>
<select id="field127862708D" name="field127862708D" class=" fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<div class="hidden"><label for="field127862708Y">Year</label></div>
<select id="field127862708Y" name="field127862708Y" class=" fsField fsRequired" aria-required="true">
<option value=""> </option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
<option value="2021">2021</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
</select>
<input data-skip-validation="" type="text" id="fsCalendar127862708Link" class="fsCalendarPickerLink hasDatepicker" style="display:none;" aria-hidden="true"><img class="ui-datepicker-trigger"
src="https://visasolutions.formstack.com/forms/images/2/calendar.png" alt="Select Date" title="Select Date" aria-hidden="true">
<div id="fsCalendar127862708" class="fsCalendar" style=" position:absolute"></div>
</div>
</fieldset>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-15" class="fsRow fsFieldRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLabelVertical fsSpan50" id="fsCell127862709" lang="en" fs-field-type="checkbox" fs-field-validation-name="Do you have any of the following credentials?">
<fieldset role="group" aria-labelledby="fsLegend127862709" id="label127862709">
<legend id="fsLegend127862709" class="fsLabel fsRequiredLabel fsLabelVertical"><span>Do you have any of the following credentials?<span class="fsRequiredMarker">*</span></span></legend>
<div class="fieldset-content">
<label class="fsOptionLabel vertical" for="field127862709_1"><input type="checkbox" id="field127862709_1" name="field127862709[]" value="NCLEX" class="fsField fsRequired vertical" aria-required="true">NCLEX</label>
<label class="fsOptionLabel vertical" for="field127862709_2"><input type="checkbox" id="field127862709_2" name="field127862709[]" value="CGFNS" class="fsField fsRequired vertical" aria-required="true">CGFNS</label>
<label class="fsOptionLabel vertical" for="field127862709_3"><input type="checkbox" id="field127862709_3" name="field127862709[]" value="No" class="fsField fsRequired vertical" aria-required="true">No</label>
</div>
</fieldset>
</div>
<div class="fsRowBody fsCell fsFieldCell fsLast fsLabelVertical fsSpan50" id="fsCell127862710" lang="en" fs-field-type="file" fs-field-validation-name="Resume / CV">
<label id="label127862710" class="fsLabel" for="field127862710">Resume / CV </label>
<input type="file" style="display: none" id="field127862710" name="field127862710" size="30"
class="fsField fsUpload uploadTypes-jpg,jpeg,gif,png,bmp,tif,psd,pdf,doc,docx,csv,xls,xlsx,txt,mp3,mp4,aac,wav,au,wmv,avi,mpg,mpeg,zip,gz,rar,z,tgz,tar,sitx">
<input type="button" class="fsFileUploadButton" id="field127862710UploadButton" aria-label="Resume / CV" value="Choose File">
<input type="button" class="fsFileUploadButton" id="field127862710DeleteButton" aria-label="Resume / CV" value="Remove File">
<span class="fsFileUploadName" id="field127862710FileName">No File Chosen</span>
<div class="showMobile">File uploads may not work on some mobile devices.</div>
<script>
(function() {
var filename = document.getElementById('field127862710FileName').innerHTML
function fileUploadClick() {
var field = document.getElementById('field127862710');
field.click();
}
function fileDelete() {
document.getElementById('field127862710').value = '';
document.getElementById('field127862710FileName').innerHTML = filename;
}
function onFileChange(event) {
if (!event.target.files || !event.target.files.length) {
return;
}
var file = event.target.files[0];
var name = document.getElementById('field127862710FileName');
name.innerHTML = file.name;
}
var button = document.getElementById('field127862710UploadButton');
button.addEventListener('click', fileUploadClick);
var field = document.getElementById('field127862710');
field.addEventListener('change', onFileChange);
var buttonDelete = document.getElementById('field127862710DeleteButton');
buttonDelete.addEventListener('click', fileDelete);
})()
</script>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-16" class="fsRow fsFieldRow fsLastRow">
<div class="fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100" id="fsCell127862711" lang="en" fs-field-type="richtext" fs-field-validation-name="">
<p><span style="font-size: 10px;">By submitting this form, you are agreeing to our </span><a href="https://visasolutions.com/terms-of-use/"><span style="font-size: 10px;"><strong>Terms of Use</strong></span></a><span
style="font-size: 10px;">. Any data you provide to us is governed by the terms of the Visa Solutions </span><span style="color: rgb(71, 85, 119);"><span
style="font-size: 10px;"><strong><a href="https://visasolutions.com/privacy-policy/" rel="noopener noreferrer" target="_blank">Privacy Policy.</a> </strong></span></span></p>
</div>
<div class="fs-clear"></div>
</div>
<div id="fsRow4884614-17" class="fsRow fsFieldRow fsLastRow fsHidden">
<div class="fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLabelVertical fsHidden fsSpan50 fsHiddenByFieldSetting" id="fsCell127862718" lang="en" fs-field-type="text" fs-field-validation-name="Source">
<label id="label127862718" class="fsLabel" for="field127862718">Source </label>
<input type="text" id="field127862718" name="field127862718" size="50" placeholder="Landing Page Europe" title="Landing Page Europe" value="" readonly="readonly" class="fsField fsFormatText ">
</div>
<div class="fs-clear"></div>
</div>
</div>
</div>
<div id="fsSubmit4884614" class="fsSubmit fsPagination">
<button type="button" id="fsPreviousButton4884614" class="fsPreviousButton" value="Previous Page" style="display:none;" aria-label="Previous"><span class="fsFull">Previous</span><span class="fsSlim">←</span></button>
<button type="button" id="fsNextButton4884614" class="fsNextButton" value="Next Page" style="display:none;" aria-label="Next"><span class="fsFull">Next</span><span class="fsSlim">→</span></button>
<input id="fsSubmitButton4884614" class="fsSubmitButton" style="" type="submit" value="Submit">
<div class="clear"></div>
<div class="">
</div>
</div>
<script type="text/javascript">
window.FS_FIELD_DATA_4884614 = [];
</script>
<script type="text/javascript" src="//static.formstack.com/forms/js/3/jquery.min_1d14cd3798.js"></script>
<script type="text/javascript" src="//static.formstack.com/forms/js/3/jquery-ui.min_42a497cb9f.js"></script>
<script type="text/javascript" src="//static.formstack.com/forms/js/3/scripts_73b8d74cfa.js"></script>
<script type="text/javascript" src="//static.formstack.com/forms/js/3/analytics_7d49daa365.js"></script>
<script type="text/javascript" src="//static.formstack.com/forms/js/3/modernizr_60a2d5aeb5.js"></script>
<script type="text/javascript">
(function() {
var isLocalStorageSafe = true;
try {
if (typeof sessionStorage !== 'undefined' && sessionStorage.fsFonts) {
document.documentElement.className = document.documentElement.className += ' wf-active';
}
} catch (e) {
console.log('Failed to read from localStorage', e.message);
isLocalStorageSafe = false;
}
var pre = document.createElement('link');
pre.rel = 'preconnect';
pre.href = 'https://fonts.googleapis.com/';
pre.setAttribute('crossorigin', '');
var s = document.getElementsByTagName('head')[0];
s.appendChild(pre);
var fontConfig = {
google: {
families: ['Nunito:400,700']
},
timeout: 2000,
active: function() {
if (!isLocalStorageSafe || typeof sessionStorage === 'undefined') {
return;
}
sessionStorage.fsFonts = true;
}
};
if (typeof WebFont === 'undefined') {
window.WebFontConfig = fontConfig;
var wf = document.createElement('script');
wf.type = 'text/javascript';
wf.async = 'true';
wf.src = ('https:' == document.location.protocol ? 'https' : 'http') + '://ajax.googleapis.com/ajax/libs/webfont/1/webfont.js';
s.appendChild(wf);
} else {
WebFont.load(fontConfig);
}
})();
if (window.addEventListener) {
window.addEventListener('load', loadFormstack, false);
} else if (window.attachEvent) {
window.attachEvent('onload', loadFormstack);
} else {
loadFormstack();
}
function loadFormstack() {
var form4884614 = new Formstack.Form(4884614, 'https://visasolutions.formstack.com/forms/');
form4884614.checks.push({
target: '127862697',
action: 'Show',
bool: 'AND',
fields: ['127862695'],
checks: [{
field: '127862695',
condition: '==',
option: 'United States 🇺🇸'
}]
});
form4884614.checks.push({
target: '127862698',
action: 'Show',
bool: 'AND',
fields: ['127862696'],
checks: [{
field: '127862696',
condition: '==',
option: 'Family/Friend'
}]
});
form4884614.checks.push({
target: '127862699',
action: 'Show',
bool: 'OR',
fields: ['127862694', '127862694', '127862694', '127862694', '127862694', '127862694', '127862694', '127862694', '127862694', '127862694', '127862694', '127862694', '127862695', '127862694', '127862695', '127862695', '127862695',
'127862695', '127862695', '127862695', '127862695', '127862695', '127862695', '127862695', '127862695', '127862695', '127862695', '127862694', '127862695', '127862694', '127862695', '127862694', '127862695', '127862694', '127862695',
'127862694', '127862695', '127862694', '127862695'
],
checks: [{
field: '127862694',
condition: '==',
option: 'Chad'
}, {
field: '127862694',
condition: '==',
option: 'China'
}, {
field: '127862694',
condition: '==',
option: 'Cuba'
}, {
field: '127862694',
condition: '==',
option: 'India'
}, {
field: '127862694',
condition: '==',
option: 'Iran, Islamic Republic of'
}, {
field: '127862694',
condition: '==',
option: 'Iraq'
}, {
field: '127862694',
condition: '==',
option: 'Libya'
}, {
field: '127862694',
condition: '==',
option: 'Russian Federation'
}, {
field: '127862694',
condition: '==',
option: 'Somalia'
}, {
field: '127862694',
condition: '==',
option: 'Syrian Arab Republic'
}, {
field: '127862694',
condition: '==',
option: 'Venezuela'
}, {
field: '127862694',
condition: '==',
option: 'Yemen'
}, {
field: '127862695',
condition: '==',
option: 'Chad'
}, {
field: '127862694',
condition: '==',
option: 'El Salvador'
}, {
field: '127862695',
condition: '==',
option: 'China'
}, {
field: '127862695',
condition: '==',
option: 'Cuba'
}, {
field: '127862695',
condition: '==',
option: 'India'
}, {
field: '127862695',
condition: '==',
option: 'Iran, Islamic Republic of'
}, {
field: '127862695',
condition: '==',
option: 'Iraq'
}, {
field: '127862695',
condition: '==',
option: 'Libya'
}, {
field: '127862695',
condition: '==',
option: 'Russian Federation'
}, {
field: '127862695',
condition: '==',
option: 'Somalia'
}, {
field: '127862695',
condition: '==',
option: 'Sudan'
}, {
field: '127862695',
condition: '==',
option: 'El Salvador'
}, {
field: '127862695',
condition: '==',
option: 'Syrian Arab Republic'
}, {
field: '127862695',
condition: '==',
option: 'Venezuela'
}, {
field: '127862695',
condition: '==',
option: 'Yemen'
}, {
field: '127862694',
condition: '==',
option: 'Eritrea'
}, {
field: '127862695',
condition: '==',
option: 'Eritrea'
}, {
field: '127862694',
condition: '==',
option: 'Nigeria'
}, {
field: '127862695',
condition: '==',
option: 'Nigeria'
}, {
field: '127862694',
condition: '==',
option: 'Sudan'
}, {
field: '127862695',
condition: '==',
option: 'Sudan'
}, {
field: '127862694',
condition: '==',
option: 'Tanzania'
}, {
field: '127862695',
condition: '==',
option: 'Tanzania'
}, {
field: '127862694',
condition: '==',
option: 'Kyrgyzstan'
}, {
field: '127862695',
condition: '==',
option: 'Kyrgyzstan'
}, {
field: '127862694',
condition: '==',
option: 'Myanmar'
}, {
field: '127862695',
condition: '==',
option: 'Myanmar'
}]
});
form4884614.checks.push({
target: '127862703',
action: 'Show',
bool: 'AND',
fields: ['127862701'],
checks: [{
field: '127862701',
condition: '==',
option: 'Yes'
}]
});
form4884614.logicFields = ['127862701', '127862694', '127862695', '127862696'];
form4884614.calcFields = [];
form4884614.dateCalcFields = [];
form4884614.init();
if (Formstack.Analytics) {
form4884614.plugins.analytics = new Formstack.Analytics('https://visasolutions.formstack.com', 4884614, form4884614);
form4884614.plugins.analytics.trackTouch();
form4884614.plugins.analytics.trackBottleneck();
}
window.form4884614 = form4884614;
};
</script>
<input name="fsUserAgent" id="fsUserAgent" type="hidden" value="Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/103.0.5060.134 Safari/537.36">
</form>Text Content
START YOUR AMERICAN DREAM WITH US! Apply here! OUR PROCESS The EB-3 visa is an Employment-Based permanent residency (Green Card) that allows skilled workers and healthcare professionals to move and work in the U.S. REQUIREMENTS HOW TO QUALIFY TO QUALIFY FOR A NURSING JOB IN THE U.S., YOU MUST HAVE: APPLY NOW! Please fill in a valid value for all required fields Please ensure all values are in a proper format. Are you sure you want to leave this form and resume later? Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form. Save and Resume Later Save and get link You must upload one of the following file types for the selected field: There was an error displaying the form. Please copy and paste the embed code again. Apply Discount You saved with code Submit Submitting Validating There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue. Please check the field: Fields General Information Name* Last Name* Phone Number* Email* Country of Citizenship* Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius And Saba Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo The Democratic Republic Of The Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Republic Of Korea Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao The Former Yugoslav Republic Of Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Federated States Of Micronesia Republic Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension And Tristan Da Cunha Saint Kitts And Nevis Saint Lucia Saint Martin (French Part) Saint Pierre And Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States 🇺🇸 United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam British Virgin Islands Virgin Islands, U.S. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe Country of Residence* Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius And Saba Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo The Democratic Republic Of The Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Republic Of Korea Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao The Former Yugoslav Republic Of Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Federated States Of Micronesia Republic Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension And Tristan Da Cunha Saint Kitts And Nevis Saint Lucia Saint Martin (French Part) Saint Pierre And Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States 🇺🇸 United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam British Virgin Islands Virgin Islands, U.S. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe How did you find out about this opportunity?* Online search Facebook YouTube Family/Friend Event Instagram LinkedIn Other What type of visa are you currently on? * Person who referred you (Referral Program): First Name Last Name Sorry! Unfortunately at this moment we are not processing cases from your country. Experience Are you currently working clinically? * Yes No What is your specialty? Critical Care ER ICU Labor & Delivery Med Surge NICU OR Pediatric PICU Telemetry Other Employer's name Education Education* Bachelor's Degree Diploma Registered Nurse Registered Midwife Registered Mental Health Nurse Certificate Associate's Degree Master's Degree Doctoral Degree Country of Education* Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius And Saba Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo The Democratic Republic Of The Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Republic Of Korea Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao The Former Yugoslav Republic Of Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Federated States Of Micronesia Republic Of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension And Tristan Da Cunha Saint Kitts And Nevis Saint Lucia Saint Martin (French Part) Saint Pierre And Miquelon Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands South Sudan Spain Sri Lanka Suriname Svalbard And Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States 🇺🇸 United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam British Virgin Islands Virgin Islands, U.S. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe College/ University Name* Graduation Date* https://visasolutions.formstack.com/forms/images/2/calendar.png Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 Do you have any of the following credentials?* NCLEX CGFNS No Resume / CV No File Chosen File uploads may not work on some mobile devices. By submitting this form, you are agreeing to our Terms of Use. Any data you provide to us is governed by the terms of the Visa Solutions Privacy Policy. Source Previous← Next→ Enter your save and resume password Cancel Confirm Online Form - Apply Now - HC - COPY YOU ARE THE PERFECT CANDIDATE! Visa Solutions, LLC is not a law firm, and the information contained in this website is provided for informational purposes only. It should not be construed as legal advice on any matter. Copyright © 2022 Visa Solutions Healthcare.