KEY QUESTIONS

& ANSWERS
For Healthcare Workers Evaluating an Offer to Work in the U.S.A.

INTRODUCTION
The following key questions and answers have been prepared to assist healthcare workers outside of the United States
of America who may be evaluating an offer to work in the U.S.

KEY QUESTIONS ABOUT BEING ABLE TO WORK IN THE U.S.

Q: WHAT IS REQUIRED FOR A NON-U.S. CITIZEN TO WORK IN THE U.S.?
A: Non-U.S. citizens must be granted a visa to be able to work legally in the U.S.

Q: WHAT IS A VISA AND WHO GRANTS IT?

A: A visa is an authorization given by a government to allow someone who is not a citizen of that country to
enter and remain in that country for a particular purpose and for a defined period of time. There are many
types of visas, including travel visas, work visas, student visas, etc. The U.S. Citizenship and Immigration
Service (“USCIS”) is the U.S. government agency responsible for approving visa petitions. You can visit USCIS
at uscis.gov.

Q: FOR WORK VISAS, WHO PETITIONS USCIS FOR APPROVAL?

A: Your prospective employer must file a visa petition on your behalf. Your prospective employer will become
your visa sponsor.

KEY QUESTIONS ABOUT MY U.S. EMPLOYER

Q: WHO WILL BE MY EMPLOYER?
A: This is one of the most important questions to ask when considering an offer to work in the U.S. In general,
there are two types of employment arrangements. You may be employed by a specific health facility, in which
case you will fall into the category known as a “Direct Hire.” Alternatively, you may be employed by a staffing
or travel nurse agency who contracts with health facilities to provide workers, in which case you will fall into
a category known as an “Agency Hire.”

Q: DOES IT MATTER WHO MY EMPLOYER WILL BE?

A: Yes. There are significant differences between a Direct Hire arrangement and an Agency Hire arrangement.
Depending on your personal situation and goals, these differences may matter to you greatly. The chart on
the next page summarizes some of the key differences between a Direct Hire and an Agency Hire
arrangement.
KEY QUESTIONS
Who is my employer & visa
sponsor?
Is the position permanent
& full-time?
Do I know where will I live
and work?
How will I get paid?
How will my pay and
benefits compare with
other people working at
the same facility?
Who will sign my job offer?
What else should I be
thinking about?
DIRECT HIRE
The specific health facility that extends
a job offer to you.
Yes. Your job offer will specifically stateUnknown. The Agency can only assign you to
this.
Yes. In the specific city and facility
specified in your job offer. You cannot
be transferred to another location
without your consent.
You will be paid by the health facility
that hired you.
You will receive the same pay and
benefits as all other nurses who have
similar qualifications and experience as assigned. In almost all cases, your pay and
you.
A recruiter hired by the health facility
will present the job offer on behalf of
the health facility. The health facility
will sign the job offer.
A Direct Hire arrangement provides
greater stability. It allows you to settle around and see different parts of the country
down in one location, have your
spouse and children find stable work
and schools, and provides you with
peace of mind knowing that you will
not be mandated to relocate during
your contract period.
AGENCY HIRE
The Staffing or Travel Nurse Agency.
contracts with health facilities that it has
available. There may be gaps in your
employment.
Unknown. The Agency may intend to place
you in a named location, but almost always
reserves the right to place you in any location
where they have needs at the time of your
arrival. They also reserve the right to relocate
you during the time of your commitment to
them. This means it is possible that you could
be living and working in several different
locations across the U.S.
You will be paid by the Agency that hired you,
regardless of where they assign you.
Unknown. Your pay and benefits are set by
the Agency regardless of where you will be
benefits will not be the same as those of other
workers at the facility to which you are
assigned.
A representative of the Agency will sign the
job offer.
Agencies offer the opportunity to move
and gain varied work experiences. The
uncertainty of knowing where you will be
placed until you are about to arrive in the U.S.
and the potential to have to relocate at a time
not of your choosing can be extremely
disruptive to family life.
KEY QUESTIONS ABOUT MY JOB OFFER
Q: HOW WILL MY JOB OFFER BE PRESENTED?
A: Job offers should always be presented in writing.

Q: I HAVE BEEN GIVEN A JOB OFFER IN WRITING. WHAT SHOULD I DO NEXT?

A: Take your time and read the job offer carefully. Make sure you understand it. You should never agree to an
offer that you do not understand. Ask the recruiter questions. Be sure that the language in the job offer says in
writing what the recruiter is telling you verbally. It is always a good idea to ask for advice from someone you
know with legal training. They may be able to help you understand the language in the job offer. Also, don’t
feel pressured by the recruiter to sign immediately. It is normal to receive up to 5 business days for you to
consider the offer and respond.

Q: SHOULD THE OFFER INCLUDE A CLEAR DESCRIPTION OF MY NEW JOB?

A: Yes. You want to be sure that the work being offered is a good fit with your professional skills and your
personal goals.

Q: DOES REPUTATION MATTER?

A: Yes. You should always feel comfortable with the reputation of the recruiter or prospective employer. You
should ask others and do your own research to determine if the people you are working with have quality
reputations.

Q: CAN I MAKE CHANGES TO THE JOB OFFER BEFORE I SIGN IT?

A: That depends. If there are aspects of the job offer that you wish to change, you can certainly request those
changes. However, the recruiter or employer may decline your requests. Once a final offer has been
presented to you, you will have to decide whether to accept that offer.

Q: CAN I MAKE CHANGES TO THE JOB OFFER AFTER I SIGN IT?

A: Generally, no changes are permitted after an offer has been accepted and signed. A signed job offer creates
legally binding obligations for both parties. Once signed, the job offer is a contract. Each party will begin to
perform its obligations as set forth in the contract. This includes financial obligations. If a party fails to perform
its obligations, it may be in breach of the contract and may be held responsible financially to the non-
breaching party.

CONCLUSION
Deciding to accept a job offer to work in the U.S. is perhaps one of the most important decisions you will ever make. The
questions and answers above have been prepared to assist you as you think about this important decision. Be sure to
ask the right questions, know who your employer will be, and understand the job offer before you sign it.

If you would like some additional information to help you understand job offers and contracts, please visit the YouTube
channel for the Alliance for Ethical International Recruitment Practices at
https://www.youtube.com/user/AEIRP4theCode/feed.