Application Form (English Version)
First Name*: Last Name*:
Address Line #1*: Contact:
Address Line #2: Home Phone:
City*: Work Phone:
State*: Cell/Mobile Phone:
Zip*: Email*:
       
Do you require sponsorship to work in the country where you would go overseas?: YES NO
Profession:
Preference: Hospital Nursing Home Homecare Adult Care Pediatric Care Travel Nursing  Others
Specialty: ICU/CCU Telemetry Emergency Room Operating Room Medical/Surgical NICU Pediatrics IV PACU Case Management Mental Health Hospice Director of Nursing Other:
What other experience do you have?
License 1: (Type, State, Exp. Date) Exp.
Preference: Hospital Nursing Home Homecare Adult Care Pediatric Care Travel Nursing  Others
Specialty: ICU/CCU Telemetry Emergency Room Operating Room Medical/Surgical NICU Pediatrics IV PACU Case Management Mental Health Hospice Director of Nursing Other:
What other experience do you have?
License 1: (Type, State, Exp. Date) Exp.
License 2: (Type, State, Exp. Date) Exp.
License 3: (Type, State, Exp. Date) Exp.
Where would you like to work or study:
Assignment Preference: Check all that apply:
Full Time Part Time Per diem Contract Daytime Evening Overnight
Date of Availability:  
Willing to work on travel assignments ?: Yes   No
How did you hear about China Overseas Nurse Centre ?: Friend   Nursing Flyers  Career Fair Nursing Fair   websites    Local Newspaper Nursing Spectrum  Healthcare Magazine Search Engine  Other:
Please indicate others:
 


Please contact us:
China Overseas Nurse Centre
Suite1327, Block A
Royal International
5 Guangzhou Road
Nanjing 210008
PR CHINA
Tel: +86 25 86890212
Fax: +86 25 51860224
Email: Please contact us:
MSN:novasedu@hotmail.com
Skype: chinanurse
www.novas-edu.com
www.overseas-nurse.com.cn
www.InternationalEnglishClub.com