Full Name: | |
Address: | |
Cell Phone: | |
Home Phone: | |
E-Mail: | |
Birth Date: | |
Place of Birth: | |
Marital Status: | |
Passport #: | |
Exp. Date: | |
I am a: |
Registered Nurse
Physical Therapist |
| Please include any information regarding any type of US visa you may have had in the past:
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Goal/Objective: | Use this space to declare what type of job and job environment you seek, and what important skills you have to support this desire. This should be only a sentence or two long.:
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Work History: | In chronological order, list the jobs you’ve held that pertain to the position you’re seeking. List the dates of the job (the exact dates, not just years), the addresses, what your main duties were and what you accomplished while you were employed in each job. Also, please include exactly how long you stayed in each position (in months and/or years). Dedicate only a few lines to each position. Mention supervisory experience, hands-on practice and what you learned:
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Educational History: | In chronological order, list your education. Include internships. This should be very basic and include dates attended and dates of graduation (including what diplomas you earned):
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Clinical Experience: | Mention in bullet-form specialized machinery with which you’re familiar and equipment you’ve used:
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Certifications/ Continuing Education: | If you’ve taken additional classes or gained endorsements, mention them briefly:
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References: | Anticipate that your future employer will check your references. Provide at least two people with whom you have worked directly and who can verify your proficiency and knowledge. Provide very specific contact information to make it easy for future employers to reach your references. Make sure you’ve warned your references that they might be contacted:
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| Do you have a visa screen?
Yes No |
| Do you have current passing language scores?
Yes No |
| What date did you take the language exams (or what date are you scheduled to take the exam)?
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| If you are an RN, do you have your CGFNS certificate?
Yes No |
| If not, when you anticipate sitting for the exam and receiving your certificate?
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| If you are a PT, do you have a current state credential evaluation, or have you applied for one?
Yes No |
| For what state?
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| If you have not received your completed state credential evaluation, when do you anticipate receiving it?
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