A CALL TO NURSE THE WORLD ENROLLMENT FORM*

Date of Birth ….Gender MaleFemale

Education Level

Education LevelDegreeDiplomaNursing Student
When did you qualify*

Do you hold a current RN license*
YesNo
Do you hold a valid license from your country of training
YesNo

Work Experience

What is your nursing specialty

Have you practiced nursing within the past 4 years
YesNo
What State/s are you interested in for employment

NCLEX Information*
Have you previously applied for the NCLEX-RN® exam*
YesNo

When would you like to sit the NCLEX RN® exam

Where would you like to sit the exam
South AfricaIndia
Have you previously taken CGFNS*
YesNo
Did you pass*
YesNo
Do you have CES certification*
YesNo
Date of Certification

Uploads in jpg/png formats*
National ID*

KCSE Certificate/Transcript*

KRCHN/BScN Certificate*

Valid practising licence*

I authorize North Coast Medical Training College to enter the information that I have provided into a database. I agree that North Coast Medical Training College or any third parties under contract with them may contact me by telephone, mail, or other electronic means in relation to the NCLEX-RN® or recruitment process, and by providing these details within this application I agree to its use in accordance with the Data Protection Statement.
I understand and agree that the information I provide will be treated confidentially and will be
accessed only by authorized personnel of North Coast Medical Training College or any third parties in association with them. My personal information, and that of my family, may be sent to third countries including the United States of America for the purpose of obtaining NCLEX-RN®, seeking employment, and the process of attaining visas. I have the right of access to and verification of the personal data kept either within a database or written records that concern me. I have the right to opt-out of these databases at any time. Subject to the above, unless otherwise authorized by me, my personal information will not be sold or transferred to third parties, other than in the event of North Coast Medical Training College being sold.
I agree*
YesNo