Healthcare Provider — Application Form – Mt. Sinai International Healthcare Staffing Group

FOR HEALTHCARE PROVIDERS — CANDIDATE APPLICATION

Unlock Your Next Career Opportunity with MSI Healthcare Staffing Group

At MSI Healthcare Staffing Group, we help physicians, registered nurses, and licensed practical nurses find rewarding opportunities that match their skills, ambitions, and preferred work environments—locally or internationally. Whether you are seeking flexibility, professional growth, or a new beginning abroad, MSI provides end-to-end support through every step of your journey, including licensing, exam preparation, visa sponsorship, and relocation assistance.

For Healthcare Providers — Application Form

APPLICATION FORM

SECTION 1:

PERSONAL INFORMATION

First Name

Middle Name

Last Name

Date of Birth (MM/DD/YYYY)

Email Address

Gender

Primary Phone Number

Alternate Phone Number (optional)

Current Address

Street Address

Apartment No. / P.O. Box

City / Town

State / Parish

Zip Code

Country

SECTION 2:

PROFESSIONAL INFORMATION

Primary Professional Title

Professional Specialization

Current Employer (if applicable)

Highest Level of Education

License Number

Have you ever worked internationally?

Other Primary Professional Title

Current Employment Status

Years of Experience in Profession

Licensing Authority/Board

License Expiry Date

If yes, specify country and duration

SECTION 3:

SERVICE PATHWAY SELECTION

Select Your Preferred MSI Program

MSI Global Direct Pathway™ – For independent practitioners seeking direct hire opportunities with healthcare facilities of their choice while retaining full control of their process. MSI provides guidance, documentation support, and compliance oversight.

MSI Professional Engagement Program™ – For practitioners seeking full MSI employment, sponsorship, and placement in Locum Tenens, Travel Nursing, or Per Diem assignments.

SECTION 4:

LICENSURE, CREDENTIALING, AND EXAM INFORMATION

Have you passed any licensing examinations (e.g., NCLEX, USMLE, CBT)?

If yes, specify exam type, year, and jurisdiction

Do you require assistance with licensing or exam preparation?

Do you currently hold active registration in your home country?

Are your credentials (education and experience) ready for verification/evaluation?

SECTION 5:

VISA AND RELOCATION DETAILS

Do you currently possess a valid work visa for your preferred destination country?

Would you require MSI’s visa sponsorship support?

Do you require relocation support (travel and accommodation assistance)?

Preferred Start Date (MM/DD/YYYY)

SECTION 6:

DECLARATION AND CONSENT

I hereby declare that the information provided above is accurate and complete to the best of my knowledge. I authorize MSI Healthcare Staffing Group to verify all credentials and documents submitted and to share relevant information with prospective employers or regulatory bodies as necessary for the purpose of recruitment, credentialing, or licensing.

I agree to the terms and conditions and authorize MSI Healthcare Staffing Group to process my application.

Type your Full Name

Once completed, please review your information carefully.
Then, click the “Submit Application” button below to send your form to the MSI Healthcare Staffing Group Recruitment Division.