Personal Information
Work Eligibity
Education & Work Experience
References & Submit

1. Profile Information

Personal Information

First Name

Middle Name

Last Name

Date of Birth

Select Gender

Social Security Number

Address Information

Street Address 1

Street Address 2 (Optional)

Zip Code

City

State

Communication Information

Home Phone

Cell Phone

Work Phone (optional)

Email Address

Confirm Email Address

May we contact you by email?

Yes

Work Availability

Please specify what shifts you are available to work

Choose all that apply

PRN Hours Only

1st Shift Monday - Friday 7:30am to 3:30pm

2nd Shift Monday - Friday 3:30pm to 11:30pm

3rd Shift Monday - Friday 11:30pm to 7:30am

Weekend 1st Shift: Saturday and Sunday 7:30am to 7:30pm

Weekend 2nd Shift: Saturday and Sunday 7:30pm to 7:30am

Have a shift perference? Leave a comment

2. Work Eligibility

3. Education & Work Experience

Education

Education #1

Education Type

Name of School or Organization

Degree Or Major

City

State

Graduation Date

Did you Graduate?

Yes

4. Training

Please select all training you have completed. This will help us determine if you are eligible for hire.

CPR

FIRST AID

MEDICATION ADMINISTRATION

Relias

Please type & add any other additional training you have ( releated to position your applying for )

5. Work Experience

Please detail your entire work history. (List past five years of job experiences beginning with most recent employment) Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”

WORK EXPERIENCE #1

Organization Name

Phone

Address

City

State

Zip

Supervisor's Name

Title

Phone Number

Email Address

6. References & Submit

Personal Reference #1

Please make sure to always keep your profile up-to-date.

First Name

Last Name

E-Mail

Home #

Cell #

Address

City

State

Zip Code

Terms and Conditions

I have read and agree to the terms and condition

STARCARE OF TENNESSEE AUTHORIZATION AND INTEGRITY RELEASE

I certify that the information provided in this application is true and complete to the best of my knowledge. I hereby authorize Starcare provider agency to investigate all statements contained in this application and agree to hold harmless from and against liability in connection with the investigation of these statements including checking of references for employment and any actions taken in pursuit to the receipt of that information.

AUTHORIZATION FOR THE RELEASE OF INFORMATION

Authorize Starcare Inc. provider agency and it representatives, vendors or agents the rights to investigate all references about me and to also secure additional job related information as deemed necessary. A copy of this page containing my signature will constitute my written consent of release of information. Furthermore, I certify to the best of my ability that I have not had any substantiated case of abuse, neglect or mistreatment against me in the past. I therefore authorize Starcare the full and complete access to any and all current personnel or investigative records from any agency as pertaining to allegations of abuse, neglect, or mistreatment of any individual that I have supported in the past or that I support currently.

Nursing Care:	We provide 24 hour Clinical Nursing Services
Transportation:	We provide Non-Emergency Transport Services
Assisted Living:	We care for our recipients from the comfort of their homes
Day Services:	We assist our recipients with meaningful daily activities

Application

1. Profile Information

Personal Information

Address Information

Communication Information

Work Availability

2. Work Eligibility

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6

Question 7

Question 8

3. Education & Work Experience

Education

Education #1

4. Training

5. Work Experience

WORK EXPERIENCE #1

6. References & Submit

Terms and Conditions

STARCARE OF TENNESSEE AUTHORIZATION AND INTEGRITY RELEASE

AUTHORIZATION FOR THE RELEASE OF INFORMATION