Tel.No.:
Fax No:
E-mail:		 (632) 6338114, (632) 6339117 (632) 6318020
 
   
Exciting NURSING OPPORTUNITIES await you in the USA
Enjoy unparalleled professional
and personal growth!
Explore our great country and experience the security and prosperity the U.S. is
well known for.
Sentosa Recruitment Agency offers real job positions and permanent residence status for Filipino nurses in the USA.
   
 
   
 

Online Application Form
Fill out the online form below and click “Submit” to send your application to us. We’ll get in touch with you to discuss your application. Alternatively, you may download the form, fill it out and fax it to (632) 631 8020.
Fields marked with an asterisk (*) are required.
PERSONAL PROFILE    
*First Name:  
*Last Name  
E-mail Address:  
Nickname  
*Address:  
   
   
*City/Province:  
*Zip Code:  
*Country:  
*Tel:   Home   Work  
Country Code Area Code  
*Mobile:  
Please contact me through my:  
Home Work Mobile Any
*Birthday:  
*Gender:  
Male Female    
*Title::  
Mr. Mrs. Miss Other
     
CURRENT EMPLOYER    
Company Name:  
Job Title/Position:  
Employer’s Address:  
   
   
   
   
Date Employed:  
From  To  
     
PREVIOUS EMPLOYER    
Company Name:  
Employer’s Profile  
Job Title/Position:  
Employer’s Address:  
   
   
City/Province:  
Zip Code:  
Country:  
Date Employed:  
From  To  
     
QUALIFICATIONS    
Nursing School:  
Province:  
Date Graduated:  
School’s Mailing Address:  
   
   
City/Province:  
Zip Code:  
Country:  
Local Code:  
Skills Summary:  
 
NURSING EXPERIENCE
State the number of months for the following.
  Number of Years/Months
*Medical
Surgical
*Operating Room:
*Critical Care:
*Other (Describe)
Have you completed the Visa Screen? Yes No
Date issued:   If not, when do you plan to apply:
Do you have a CGFNS Certificate? Yes No
If so, date issued:  
If not, when do you plan to apply?  
Have you passed the NCLEX? Yes No
If so, date passed:  
If not, when do you plan to take the exam?  
Have you worked outside the Philippines? Yes No
If so, where:        Dates:  From      To
Do you have any relatives in the U.S.? Yes No
Relationship:
If yes, where:         City State
Do you have any health problems? Yes No
If yes, please describe:
Do you have any physical limitations? Yes No
If yes, please describe:  
 
DOCUMENT CHECKLIST
Let Sentosa Recruitment Agency assist you in completing your requirements. Simply tick the appropriate box of those requirements that you already have.
Resume
Transcript of Records
Nursing Diploma
Board Certificate
Employment Certificate
NCLEX / CGFNS Certificate or in the process of obtaining CGFNS Certificate or RN License
TOEFL / TSE / IELTS Certificate for the processing of ICHP Certification
Visa Screen Certificate
PRC License
Certificate of Seminars / Trainings
2 copies of 2x2 pictures
Passport
                                                                   
 
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