1433 State Highway 34

Building C5
Farmingdale, NJ 07727 - USA
Tel # 212.255.2598
www.dshealthcare.org

Candidate Application Form

Section 1: Please check your applicable profession

Registered Nurse Physical Therapist Physical Therapy

Assistant
Occupational Therapist Medical Technologist Respiratory Therapist
Pharmacist Surgery Tech Medical Imaging
X-Ray Technologist Paramedic/EMT Researcher

Other, please indicate:      

Section 2: Profile Information - As you enter your information, the boxes will
expand

First Name: Margie Middle Name: Cabalan

Last Name: Biscante Nick Name: Marg
Address: #08 Camia St. Blk-1 VergonVille Subd. Pulanglupa II,
City: Las Piñas State:       Zip:      
Country : Philippines
Phone numbers - Please enter numbers only. No spaces or dashes are allowed
Home: 28712985 Cell: 9496855625
Work:       Extn:      

Email: marjiebiscante@yahoo.com

Section 3: Education

Please indicate highest level of education achieved: College Graduate

University/College Attended: San Juan de Dios Educational Foundation Inc. (College)
Location/Campus: Pasay City
City: Pasay City State/Territory:      
Country : Philippines
Indicate the Degree Awarded: Bachelor of Science in Nursing
Graduation Date (MM/YYYY): March 2007

Section 4: Professional Experience

Total Years of Experience: 2

Specialty Areas (Select and specify years of experience for each area that is applicable to
you):
In a Hospital Setting       In a Rehab facility      
In Home Care Setting       In a Clinic      
Section 5: Questionnaire

1a. Have you passed the U.S. qualifying exam for your profession? Yes No
1b. If Yes, what examination did you take:      
1c. When did you pass? (MM/YYYY):      
1d. For which state in the U.S.?      
2a. Have you applied to any credentialing authority for evaluation of your education?
Yes No
2b. If Yes, name of the credentialing authority:      
2c. For which U.S. state(s) was the evaluation completed?      
3a. Do you hold any certifications or have you taken any certification exams? Yes
No
3b. If yes, which exams/certifications? Please indicate the month and year taken and the
result:

Exam/Certification Month/Year Taken Passed (Y/N)

                 
                 
                 
                 
                 
                 

4a. Do you currently hold a license for your profession? Yes No

4b. If yes, please indicate the state, territory or country:      
5a. If educated outside the U.S. and its territories, have you taken the English proficiency
examinations required for Visa Screen? Yes No
5b. If yes, which English exams did you take? Please indicate the month and year taken and
the result:

English Exam Month/Year Taken Passed (Y/N)

                 
                 
                 

6a. Languages - Rate your capabilities:

English WRITING: Fluent Somewhat Fluent Very Little
SPEAKING: Fluent Somewhat Fluent Very Little
Spanish WRITING: Fluent Somewhat Fluent Very Little
SPEAKING: Fluent Somewhat Fluent Very Little
Other      

Once you have completed the form, Please click: File  Send to  Mail Recipient (as
attachment) or Save the form on your computer as a Word document.

Send your completed form via email to careers@dshealthcare.org. Please attach a

resume to this email as well, if you can.
Thanks for your application. You will hear back shortly from one of our Recruiters.