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The procedure for applying to the U.K. and U.S.A. are different.

Please go through the FAQ's for clarification. You need to send us your resume, credentials, testimonials, etc. and fill in the application forms.

Once we receive your application we will review it carefully and match it with the requirements of our Clients. We will then short list you for the corresponding interview and email or write to you with details. Having an email address aids us in contacting you. Our success rate for placing a candidate is very high so you stand a very good chance of landing the best job in the shortest possible time.

You can send in your resume based on the format provided online or you can make use of the format and then mail in your CV to the contact address given below:

INDIA
SRS Healthcare Pvt. Ltd.
401 D, Poonam Chambers A Wing,
Dr. Annie Besant Road,
Worli – Mumbai 4000 18
Phone: 24961001/2/3
Fax: 24961004
Email: info@srscare.com

VIETNAM
2/1 Hong Ha St,
Tan Binh Dist.,
Ho Chi Minh City - Vietnam.
Phone: + 84 8 8487191
Fax: + 84 8 8485658
Email: vn@srscare.com

PHILIPPINES
Opening Shortly

NURSE APPLICATION FORM
Please complete the form below and we will contact you shortly.

	First Name:
	Last Name:
	Middle Initial:
	Home Address:
	City:
	State/Province:
	Zip:
	Country:
	Current Address (if different from home):
	Email:
	Home Phone:
	Current Phone:
	Work Phone:
	Cell Phone:
	Fax Number:
	In case of emergency, contact:
	Relationship:
	Phone:
	Are you a registered nurse?	Yes No
	Have you ever been convicted of a crime?	Yes No
	Do you have a U.S. Social Security Number?	Yes No
	Have you taken NCLEX?	Yes No
	From which State?
	Did you pass?	Yes No
	NCLEX License #:
	Expiration Date:
	Did you review for NCLEX exam?	Yes No
	Do you have any other state licenses?	Yes No
	Have you taken CGFNS?	Yes No
	Do you have a CGFNS certificate?	Yes No
	Have you ever taken the TOEFL?	Yes No
	Did you pass the exam?	Yes No
	Have you ever taken the TSE?	Yes No
	Did you pass the exam?	Yes No
	Have you ever taken the IELTS?	Yes No
	Did you pass the exam?	Yes No
	Spoken Score:
	Do you have an IELTS certificate?	Yes No
	Are you currently in the United States?	Yes No
	If yes, what is your current immigration status?
	How did you hear about us?	Google.com Yahoo.com Other search Engine Internet/Web Ad Directmail
	Magazine/Journal
	Newspaper
	Job Fair
	Referral

	EDUCATION AND TRAINING:
	High School	Name and Address of School
		Month/Year Graduated:
		Diploma/Degree:
	College	Name and Address of College
		Month/Year Graduated:
		Diploma/Degree:
	Graduate School	Name and Address of School
		Month/Year Graduated:
		Diploma/Degree:
	Other School (if applicable)	Name and Address of School
		Month/Year Graduated:
		Diploma/Degree:


	CURRENT CERTIFICATIONS:
	BLS ACLS PALS NRP TNCC CHEMO OTHER'S


	SPECIALITY	PRIMARY	FLOAT
	MEDICAL SURGICAL-Adult
	Diabetic Unit	Yrs:	Yrs:
	Gastrointestinal Unit	Yrs:	Yrs:
	General Surgery	Yrs:	Yrs:
	Genitourinary Unit	Yrs:	Yrs:
	Geriatric Unit	Yrs:	Yrs:
	Gynecology Unit	Yrs:	Yrs:
	Hematology Unit	Yrs:	Yrs:
	Hemodialysis Unit	Yrs:	Yrs:
	Home Health	Yrs:	Yrs:
	Hospice Unit	Yrs:	Yrs:
	Renal Unit	Yrs:	Yrs:
	Neurology Unit	Yrs:	Yrs:
	Oncology Unit	Yrs:	Yrs:
	Outpatient Clinic	Yrs:	Yrs:
	Pulmonary Unit	Yrs:	Yrs:
	Radiology Services	Yrs:	Yrs:
	Rehabilitation Unit	Yrs:	Yrs:
	Same Day Surgery Unit	Yrs:	Yrs:
	Skilled Nursing Facility	Yrs:	Yrs:
	Clinic	Yrs:	Yrs:
	Other	Yrs:	Yrs:
	MEDICAL SURGICAL-PEDS
	General Peds Unit	Yrs:	Yrs:
	Home Health	Yrs:	Yrs:
	Hospice Unit	Yrs:	Yrs:
	Oncology Unit	Yrs:	Yrs:
	Rehab Unit	Yrs:	Yrs:
	Other	Yrs:	Yrs:
	PRENATAL
	Antepartum Unit	Yrs:	Yrs:
	Labor & Delivery	Yrs:	Yrs:
	LDRP	Yrs:	Yrs:
	High Risk Labor & Delivery	Yrs:	Yrs:
	Mother Baby Unit	Yrs:	Yrs:
	NICU Level II	Yrs:	Yrs:
	NICU Level III	Yrs:	Yrs:
	Fetal Monitoring	Yrs:	Yrs:
	Newborn Healthcare	Yrs:	Yrs:
	PERINATAL-cont
	Postpartum Unit	Yrs:	Yrs:
	Other	Yrs:	Yrs:
	PERIOPERATIVE
	Cardiovascular OR	Yrs:	Yrs:
	Neurosurgical OR	Yrs:	Yrs:
	Operating Room	Yrs:	Yrs:
	Orthopedic OR	Yrs:	Yrs:
	Same Day Surgery	Yrs:	Yrs:
	Transplant OR	Yrs:	Yrs:
	ENT/Ophthalmology OR	Yrs:	Yrs:
	Bone Marrow Transplant OR	Yrs:	Yrs:
	CRITICAL CARE-Adult
	Burn ICU	Yrs:	Yrs:
	Cardiac ICU	Yrs:	Yrs:
	Cardiac Catheterization Lab	Yrs:	Yrs:
	Emergency Room	Yrs:	Yrs:
	Medical ICU	Yrs:	Yrs:
	Neuro ICU	Yrs:	Yrs:
	Neurosurgical ICU	Yrs:	Yrs:
	Transplant ICU	Yrs:	Yrs:
	Surgical ICU	Yrs:	Yrs:
	Telementry/Stepdown	Yrs:	Yrs:
Post-Op Open Heart	Yrs:	Yrs:
CRITICAL CARE-Peds
Burn ICU Peds	Yrs:	Yrs:
Cardiac Catheterization Lab	Yrs:	Yrs:
Emergency Room Peds	Yrs:	Yrs:
Pediatric ICU	Yrs:	Yrs:
Pediatric - Transplant ICU	Yrs:	Yrs:
Pediatric_Step-down_Unit	Yrs:	Yrs:
PSYCHIATRY
Adolescent Psychiatric	Yrs:	Yrs:
Dual Diagnosis Unit	Yrs:	Yrs:
Adult	Yrs:	Yrs:
Pediatric Psychiatric Unit	Yrs:	Yrs:
Emergency Room	Yrs:	Yrs:
Correction Facility	Yrs:	Yrs:
Other Fields of Nursing:
Clinic Nursing:
Area:	Years of Experience:
Long Term Care:	Years of Experience:
Other: (Please Explain)

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