Crossroads Workforce Solutions

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Application Form

Please fill out the form below to apply for opportunities with U.S. employers. We are requesting some additional background information because we would like to take the time to match you with a company that aligns with your skills and aspirations. Providing this information is entirely optional.

Full Name *

Date of Birth *

Contact Number (Philippines or US) *

Email Address *

Current Address (Philippines) *

Where Did You Grow Up? *

Highest Level of Education *

Work History

Job Title 1 * Employer * Duration (e.g., MM/YYYY - MM/YYYY) * Responsibilities

Job Title 2 (if applicable) Employer Duration (e.g., MM/YYYY - MM/YYYY) Responsibilities

Certifications

Certification 1 * Date Obtained *

Certification 2 (if applicable) Date Obtained

NCLEX Exam Status *

NCLEX Exam Date (if applicable)

NCLEX Score (if passed)

Tell Us About Yourself *

Preferred Industry in the U.S. *

Current Visa/Work Permit Status (if any)