PRELIM SCREENING QUESTIONNAIRE

Please answer the following questions as part of our pre-screening process.

Name: Arvin Jayden D. Balagtas

Date of Birth: August 3 1989

Date Graduated/School: March 2011 @ Metropolitan Hospital College of Nursing

Board Rating: 82.6%

Number of Years of Hospital Experience: 3 yrs.

Are you currently employed as a Nurse in a hospital? YES

If you are not currently employed as a Nurse in a hospital, when was your last day of employment in a
hospital? ______________________

What is your area of specialty? Hemodialysis Years of experience in specialty: 3 yrs.

Have you taken the IELTS? NO / Please specify if UKVI or Regular Academic.

If No, When do you plan to take the IELTS? March 12 2016

If Yes, what is your score in:

Reading: ___________ Listening: ___________ Writing: _________ Speaking: __________

Have you registered at the NMC? NO / Have you passed the CBT? NO

If you have registered for IELTS, when is the date of your exam? March 12 2016
(please provide evidence of registration)

Do you have a valid passport? YES

Please refer other Nurses.

OTHER USEFUL INFORMATION:

Im a member of Renal Nurses Association of the Philippines. Im a Certified Renal Nurse.