Personal information:
Name________ _____________ Birth Date_____
Phone number_ _____________ Gender_______
Address______ _____________ Email________
Accreditation process:
What month and year did you open a
file with the RNABC? __ _____________
How many months did it take to get
your (1)PRC papers: (2)Transcripts:
Month
and year Score Passed Waived
TOEFL
1. _ YES NO
YES NO
2. _ YES NO YES NO
TSE
1. _ YES NO YES NO
2. _ YES NO YES NO
IELTS
1. _ YES NO YES NO
2. _ YES NO
YES NO
Interim Permit: Employer How many months?
Did you have to take any qualifying courses? YES NO If
yes, then…
Courses taken_ _____________ How
many months?______ _____________ Cost
Did you take a refresher course? YES NO If yes, then…
Where did you take the course?______ _____________ How
many months was it? _____________ Cost_________
Cdn Nursing Exam: Year and month:
Score Did you pass? YES NO
Immigration to Canada:
What year and month did you arrive in
Canada?______
How did you come to Canada?
Family Sponsorship How did your family member come to Canada?
Independent Immigrant How were you able to get occupationalpoints?
Provincial Nominee Program What province did you enter?
How many months until you got landed
status?
Temporary worker’s visa Who was your employer?
Did you apply for landed status after?
Live-in Caregiver Program
Did you take a course? YES NO Cost
of course: $
If you worked under the LCP, did you take care of
q children q
elderly q people with disabilities
What is your current immigration status? citizen/
landed immigrant/ open visa/
working visa
What were your jobs before becoming a
nurse?
What is your present source of income?
Background in
Philippines:
What town are you from: _____
Nursing School_____________ Month
and year of graduation?_
Nursing position Start
(month & year) End
(month & year) Paid or volunteer?
1.___________ _____________ _____________ _____________ _____________ _____________ _____________ _____________
2.___________ _____________ _____________ _____________ _____________ _____________ _____________ _____________
Date of last practice_____________ Country of last practice______
CGFNS: Date taken________ Did you pass?_
Filipino
Nurses Support Group:
How did you hear about FNSG?
When did you first contact FNSG?
Date of membership:
Paid ($10/year)
Skills and interests______