BETTY’S LAW OFFICE IMMIGRATION SCREENING FORM FOR NURSES/ PSW

IDENTITY

First Name *
Middle Name
Last Name *
Date of Birth *
Enter Field Title *

CONTACT INFORMATION

Email Address *
Cell Phone

Current Address

Street Address
Street Address 2
City
1. Which area would you like to pursue in Canada*
Registered Nurse
Registered Practical Nurse
Personal Support Worker
2. Do you hold a 4-year bachelor’s degree in a nursing program or a practical nursing diploma?*
Yes
No
3. Did you graduate from a nursing program in general patient care and surgery?*
Yes
No
4. Do you hold a nursing license in your country?*
Yes
No
5. Are you proficient in English/ French?*
Yes
No
6. Do you have 2-5 years of work experience in patient care within the last 7 years?*
Yes
No
7. For a PSW position, do you have a Secondary school certificate?*
Yes
No
Signature *
Clear
Date *
Submit

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