* Indicates required field Application Legal First Name:* Legal Last Name: * Country: * - Select One - Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Central African Repu Central African Republic Chad Channel Islands Chile China Colombia Comoros Congo (Brazzaville) Congo-Republic of Cook Islands Costa Rica Côte d`Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fed. States of Micronesia Fiji Finland France French Guiana French Polynesia Gabon Galápagos Islands Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Holland Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, South Kuwait Kyrgystan Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxemborg Luxembourg Macao Macedonia Madagascar Madeira Islands Malawi Malaysia Maldives Mali Malta Mariana Islands Marshall Islands Mauritania Mauritius Mayotte Mexico Moldova Monaco Mongolia Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papau New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Réunion Romania Russia Rwanda Saint Kitts and Nevis Saipan Samoa San Marino São Tomé & Príncipe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St. Lucia St. Vincent & The Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Uzbekistan Vanautu Vatican City Venezuela Vietnam Virgin Islands Wales Western Sahara Yemen Yugoslavia Zambia Zimbabwe Email: * Phone: * Professional Discipline: * - Select Discipline - Registered Nurse Specialty: * Years of Experience: * Select experience Student Nurse 0 - 12 months 13 - 17 months 18 months - 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years and greater Unknown Type of Education: * Select One Certificate Diploma BSN MSN Post Graduate Country of College: * - Select One - Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Central African Repu Central African Republic Chad Channel Islands Chile China Colombia Comoros Congo (Brazzaville) Congo-Republic of Cook Islands Costa Rica Côte d`Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fed. States of Micronesia Fiji Finland France French Guiana French Polynesia Gabon Galápagos Islands Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Holland Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, South Kuwait Kyrgystan Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxemborg Luxembourg Macao Macedonia Madagascar Madeira Islands Malawi Malaysia Maldives Mali Malta Mariana Islands Marshall Islands Mauritania Mauritius Mayotte Mexico Moldova Monaco Mongolia Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papau New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Réunion Romania Russia Rwanda Saint Kitts and Nevis Saipan Samoa San Marino São Tomé & Príncipe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St. Lucia St. Vincent & The Grenadines Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Uzbekistan Vanautu Vatican City Venezuela Vietnam Virgin Islands Wales Western Sahara Yemen Yugoslavia Zambia Zimbabwe Graduation: (month/year): * Month January February March April May June July August September October November December Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Are you currently authorized to work in the United States? * Yes No Have you passed the US RN Licensure Exam? * Yes No Has a US Immigrant Visa ever been filed on your behalf? * Yes No What is the priority date? * Have you ever had a VisaScreen Certificate? * Yes No Date * Have you passed the academic IELTS or TOEFLiBT exam within the last 18 months? * Yes No Date * By submitting this form, you are consenting to receive marketing communication from O’Grady Peyton International and are agreeing to the Privacy Policy and Terms of Service. 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