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   Visa Process

Visitor's Visa

To sit for the NCLEX-RN exam, you have to go to US. For that purpose, you must apply for a visitor’s visa. To apply for a visitor’s visa, you have to pay a non refundable application fee of $ 45. You must submit form no: OF-156. Filling up and submitting this form is quite simple. You must have a valid passport and must also submit passport size photographs, showing your full face. Your head must not be covered and the color of the background must be light. You must also show sufficient evidence that you have sufficient funds to take care of the costs of traveling and staying in US. CARE ORIGIN will provide you with a sponsorship letter. You are not permitted to work during that period. You must also be aware that once you get a visa in India, it does not guarantee you an entry into the US. The U.S. Immigration and Naturalization Service (INS) has the authority to deny admission. The INS will also decide the period of your stay. To work in the US you must have a US RN (Registered Nurse) license. CARE ORIGIN will help you prepare for the US RN Licensing Exam (NCLEX-RN) - we offer study programs, review seminars, and ongoing personal support.

There is one important aspect that you have to observe. The US Immigration and Nationality Act presumes that every person who applies for a visitor’s visa has an intention of being an immigrant. Hence, you have to show the consular officer that you intend to come back.

Types of visas to foreign health professionals

CARE ORIGIN will sponsor your U.S. temporary or permanent residency visa (Green Card).

1. I-140 - Employment-based Permanent Residency (Green Card)
The immigration method with the fewest requirements on the nurse and employer is to apply for an employment-based green card. This allows a nurse to work in the U.S. indefinitely, as long as the green card is renewed every ten years.

Nursing is one of the few professions that does not require a labor certification to be filed before applying for an I-140 (unlike physicians), so I-140`s can be approved in three to six months.

The immigration process begins when an employer submits an immigrant visa petition (Form I-140) to the office of the Immigration and Naturalization Service (INS) having jurisdiction over the nurse’s place of intended employment. The petition must be accompanied by Labor Department forms ETA-750A and B and proof of the employer’s ability to pay the prevailing wage offered to the employee. When submitting the I-140 the RN must be in possession of:

a) A diploma from a nursing school in his/her country;
b) An RN license in his/her country; and
c) A full and unrestricted license to practice professional nursing in the State of intended employment or a certification that she has passed the examination given by the Commission on Graduates of Foreign Nursing Schools (CGFNS) which includes a credential review, a nursing examination, and the TOEFL.

The regulations governing this process state that the nurse must have the CGFNS certificate or be fully licensed in the state of intended employment in order to file an immigrant petition. The INS, however, has indicated a willingness to accept the NCLEX in place of the CGFNS certificate. It is most common for nurses to obtain the CGFNS certificate prior to taking the NCLEX for several reasons. The first and foremost reason is that many states require that foreign nurses pass the CGFNS examination before taking the state RN licensing (NCLEX) examination.

Under new INS regulations, the Adjustment of Status application can be filed concurrently with the I-140 for those aliens who are eligible to file such an application. The process is described below.

Consular Processing (For Nurses located outside of the United States)
The INS first sends the approved visa petition to the National Visa Center (NVC) in Portsmouth, New Hampshire. If there is no backlog for immigrant visas from the RN’s native country (her “priority date” is “current”), the NVC forwards a packet to the nurse or his/her attorney containing biographical information forms to be completed by his/her and his/her family members, and a list of documents which must be presented at his/her interview for permanent residence. Generally, the forms are submitted directly to the U.S. consulate. For individuals from certain countries, forms are submitted to the National Visa Center for preliminary processing. The NVC completes preliminary processing for cases for persons from, among others, the Philippines, Canada and China. Upon completion of preliminary processing, the NVC will forward the case to the appropriate U.S. Consulate for final processing.

The U.S. consulate where the nurse will have his/her interview for permanent residence will review specific forms and documentation. At this interview, the nurse must present various documents including the following:

  • Application for Immigrant Visa
  • Police Clearance
  • Birth Certificate
  • Marriage Certificate, if any
  • Divorce or Death Certificate of Spouse, if any
  • Valid Passport
  • Medical Examination
  • Photographs. Recent job offer letter (or employment contract)
  • Financial information regarding employer
  • Government filing fee
  • Visa Screen Certificate

Adjustment of Status to Legal Permanent Resident (for those health care professionals in valid visa status present in the U.S.)

Currently, all employment based visa categories are current. Nurses can apply for adjustment of status concurrently with the I-140 filing or immediately upon its approval. The adjustment of status for a nurse will not be granted unless and until Visa Screen is submitted. The adjustment of status package needs to include:

  • Form I-485, Application to Register Permanent Residence or Adjust Status (with two immigration-style photos)
  • Form I-765, Application for Employment Authorization (with two immigration-style photos)
  • Form G-325A, Biographic Information
  • Form I-131, Application for Advance Parole (if travel permission is being requested)(with two immigration-style photos)
  • Medical Examination sealed original
  • Birth Certificate with certified English translation
  • Marriage Certificate with certified English translation, if any
  • Divorce or Death Certificate of Spouse with certified English translation, if any
  • Verification offer of employment or employment contract
  • Necessary filing fees and fingerprinting fee
  • Copies of valid passport
  • Valid I-94 card
  • I-140 approval notice, receipt notice or concurrent filing.

Dependents will need to submit separate packages which can be filed concurrently with the principle’s application.

2. H-1B - For Positions Requiring at Least a Bachelor`s Degree
The H-1B visa can be used to hire skilled professionals that have at least a bachelor`s degree and are filling a position that requires the same level of education.

Most registered nurses and nursing jobs do not meet this requirement, but if the US employer is hiring foreign nurses for supervisory or management positions, or for subspecialty areas that require a bachelor`s degree, an H-1B might be an option.

Employers must follow a two step process to obtain an H-1B for a professional employee:

a. Department of Labor - Labor Condition Application. The employer must determine the prevailing wage for the occupation and the actual wage being paid by employer to other professionals in the same field. They must pay whichever is higher. The safest way to establish the prevailing wage is to obtain an opinion from the State Workforce Agency (SWA). We can also obtain prevailing wages on-line from OES. Once the employer has established the prevailing age it needs to submit a Labor Condition Application (LCA) to the Department of Labor (DOL). There are many attestations that the employer needs to make to the DOL when signing the LCA.

b. Immigration and Naturalization Service. The employer then submits the petition (Form I-129) to the INS Service Center having jurisdiction over the place of employment. The INS will review the individual credentials to fill the specialty occupation. If the application is approved and the applicant is outside the U.S. the INS will notify the Consulate abroad of the visa approval and the applicant will need to appear for an interview to review admissibility issues. At this point in time the Department of State’s Visa Screen is being waived for individuals applying for non-immigrant visas.

To obtain an H-1B for a nurse, the petitioner must present evidence that the nurse holds a license in the state of intended employment or that the license that the nurse holds is recognized by the state of intended employment, e.g. a compact state. Some states will issue temporary or interim licenses where the nurse completes all of the necessary prerequisites to register for the NCLEX.

More specifically, the H-1b petitioner will need the following: - Petition for Nonimmigrant Worker (Form I-129) and H Supplement with filing fees of $1,130.00

- An approved Labor Condition Application from the Department of Labor that confirms that the employer will pay a salary that meets or exceeds the prevailing wage for the position offered in the area of intended employment. Often the McNamara-O'Hara Service Contract Act ("SCA") determines the prevailing wages for nurses. The SCA provides protection for the employees to receive the prevailing wage and standard fringe benefits, including vacation, holiday, health and welfare.

- A letter from the petitioner describing the duties and responsibilities to demonstrate that a Bachelor's Degree in the field of nursing from a U.S. university or its foreign equivalent is required. A supervisory position will meet the requirement of needing a Bachelor's Degree.

- The beneficiary's degree and a foreign credentials evaluation, if the degree is from a non-US university or college, to prove that he/she has the equivalent of a U.S. degree.

- A state license in the area of intended employment or evidence that the nursing candidate has a Commission of Foreign Graduate Nursing Schools ("CGFNS") Certificate indicating that he/she has passed the CGFNS qualifying exam and the Test of English as a foreign language ("TOEFL") and possesses a temporary state license.

H-1B visa holders may also bring their family members with them on H-4 visas. The spouse and children under 21 years of age are not permitted to work, but may attend school.

Additionally, if your facility hires nurses with bachelor’s degrees almost exclusively, it is possible to make a case for using the H-1B to bring in international nursing talent.

Depending on where your facility is located, approval of an H-1B visa can take anywhere from two to six months.

H-1B`s last for three years, and can be renewed for another three.

3. TN - For Canadian or Mexican Nurses
Canadian citizens who are licensed RNs in a province or state or who have an interim permit to practice in the state of intended employment can enter the United States with a TN visa under the North American Free Trade Agreement (NAFTA). A TN visa is only valid for one year and, while there are no limits on the number of years a TN can be renewed, each renewal is valid only for one year. The nurses need not be born in Canada only possess Canadian citizenship, however, the TN visa requires that a Canadian nurse receive his/her nursing education in Canada or the United States. Mexican citizens also may enter the United States with a TN visa as a RN. However, Mexican citizens are required to obtain advance approval of a TN visa prior to entering the US. Canadian citizens are not required to obtain advance approval and may apply for a TN visa at a land border or airport.

4. H-1C - For Facilities in Underserved Areas
The H-1C visa was created in 1999 specifically for hospitals in areas with low primary care physicians-to-patient ratios, typically in rural or inner-city locations. Facilities must meet additional stringent standards, so stringent, in fact, that the U.S. Department of Labor identified only 14 hospitals that qualified to hire nurses on H-1C visas. These 14 hospitals face additional restrictions: only 500 H-1C visas will be issued each year by the INS, and the program limits the number of H-1C`s issued in each state to either 25 or 50, depending on the state population.

H-1C visas are valid for three years, and usually take two to six months to approve.

The Immigration and Naturalization Service (INS) will determine who receives an H-1C visa based on the following requirements. A nurse must:

  • have a full and unrestricted license to practice professional nursing in the country where they obtained their nursing education or have received nursing education in the United States;
  • have passed an appropriate examination (determined by the Department of Health and Human Services), or have a full and unrestricted license to practice as a registered nurse in the state of intended employment; and
  • be fully qualified and eligible under the state laws and regulations of the state of intended employment to practice as a registered nurse immediately upon admission to the United States.

Screening requirements for the H-1C Visa

CGFNS will be certifying that the nurse:
1. already possesses a valid and unencumbered licenses as a nurse in a state where the alien intends to be employed and such state verifies that the foreign license of alien nurses are authentic and unencumbered;
2. has already passed the National Council Licensure Examination for registered nurses (NCLEX-RN®); and is a graduate of a nursing program
(a) in which the language of instruction was English,
(b) located in a country designated by CGFNS within 30 days of the date of enactment of P.L. 106-95 , based on CGFNS’ assessment that the quality of nursing education in that country, and the English language proficiency of those who completed English-language-medium programs in that country justify the country’s designation, and
(c) if that nursing program was in operation before November 12, 1999, or is subsequently designated by CGFNS and any equivalent credentialing organizations approved for the credentialing of nurses under subsection 212(a)(5)(C).

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