International Nurse Intake Form

This is a demo store for testing purposes — no orders shall be fulfilled. Dismiss

This form is for nurses and caregivers in Jamaica, the USA or other countries who want support with training, preparation and connections through the Brilliant Quality International Nurse Support Program.

We do not provide immigration advice. Our focus is on training, documentation and career support.

Personal Information

Full Name *

Year of Birth (YYYY)

Phone / WhatsApp Number *

Email Address *

Current City & Country *

Professional Background

Your Profession / Role * Years of Experience in Healthcare Current Workplace / Status Main Qualifications / Certificates

Visa & Work Status

Current Visa / Work Status * Additional details about your visa / status (optional)

Your Goals & Type of Support

What are you hoping to achieve? * What type of support are you most interested in? *

Training & Upskilling (HHA, PCA, elder care, internships) Local Experience in Jamaica Support as a Nurse With U.S. Visa Support as a U.S.-Based Nurse / Caregiver Connections to Agencies / Employers (where possible) Other (explain in comments)

Which country / region are you most interested in for future opportunities?

Training & Internship Interest

Which Brilliant Quality training or internships interest you? (optional) When would you like to start?

Anything Else You Want Us to Know

Additional comments or questions When you click submit, your email app may open with these details. Just press “Send” to complete your intake. Our team will review your information and contact you through WhatsApp or email.