Employment

Employees of StarResource, L.L.C. and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, national origin, disability, marital status, gender or age.

As a means of accommodation to persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained by notifying StarResource, L.L.C. at (314) 432-7827.

StarResource requires all employees to complete an employment application, interview, reference checks, criminal record check, competency tests, Employee Disqualification List (EDL) check, Family Care Safety Registry Screening (FCSR), U.S. Dept of Health & Human Services Office of Inspector General Exclusion Search, Employment Eligibility Verification (I-9) and more. Each caregiver completes extensive orientation and training including-Company Policies and Procedures, Dementia & Alzheimer’s disease, Abuse & Neglect, client introduction & client specific training and more.

Applicants may complete and submit the Online Employment Application below or download, print and complete the Employment Application. Call (314) 432-7827 to schedule an application interview appointment.

Click here to Download Employment Application

Online Employment Application

An Equal Opportunity Employer

Employees of StarResource, L.L.C. and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion,political affiliation, national origin, disability, marital status, gender or age.

Position(s) applied for (list all)-

Referred by-

Social Security Number

(Note: Completion of number two is optional. Failure to submit social security number on this form will not prohibit employment consideration. Social security number may be required on other forms prior to employment.)

Last Name

First Name

Middle Name

Street Address

City

State

Zip

Home Phone

Alt./Mobile Phone

E-mail Address

EDUCATION

A. Check highest grade completed

123456789101112

B. If you did not complete high school, do you have a high school equivalency diploma?

YesNo

C. Check number of years of post high school education

1234567 or more

Name and Location of Institution Attended

Hours

Degree Received

Major or Specialty

Minor

Dates Attended

D. If you expect to complete an educational program in the near future, please indicate what type of degree or program and expected completion

EXPERIENCE

Use Supplementary Experience Form(s) for additional space. Starting with the most recent, describe ALL paid, military and applicable voluntary
experience. Highlight your knowledge,skills and abilities which best demonstrate your qualifications for this position. You may list significantly different jobs within the same organization as separate items.

A. Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

B. Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

C. Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

D. Use this space for any additional information you think would help us evaluate your application, including training, seminars, workshops, and special achievements or specialized skills:

E. License, certificate or other authorization to practice a trade or profession.

Type

License Number

Granted by (licensing board)

10.REFERENCES

List names, addresses and relationships of three persons not related to you who know your qualifications:

Name

Address

Phone

Relationship

11.MISCELLANEOUS

A. Check which shift you will accept: DayEveningNightRotatingWeekends Specify shift

B. List the geographic locations in which you are NOT willing to work. If willing to work anywhere, write "ALL"

C. For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States? YesNo

Under the Immigration Reform and Control Act of 1986, you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. Further, you will be required to provide documentation to that effect should you be employed.

D. Are you willing to provide your own transportation if necessary for your employment? YesNo

E.1. Have you ever been convicted, found guilty, plead guilty or entered a plea of nolo contendere for any violation(s) of law, except minor traffic offenses? YesNo
E.2. Do you consent to a check of closed records? YesNo

Description of offense :

Statute or ordinance (if known ):

Date of Charge:

Date of Conviction:

(For additional convictions use plain paper. Include all information listed above.)

12. When will you be available to start work?

13.CERTIFICATION: Each Application Requires Current Date and Original Signature

"I hereby certify that all entries and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment in the service of StarResource, L.L.C. I understand that all information on this application is subject to verification. I consent to a criminal history background check including a check of closed records. Upon hire, if I am required and not already registered, I agree to make application for registration in the Family Care Safety Registry within fifteen (15) days of the beginning of employment. I understand that any person who fails to submit a completed registration form to the Department of Health without good cause, as determined by the department, is guilty of a class B misdemeanor. I also consent that you may contact references, former employers and educational institutions listed regarding this application. I further authorize StarResource, L.L.C. to rely upon and use, as it sees fit, any information received from such contacts. I agree not to seek or accept employment, independently contract or otherwise perform services for any client for a period of one (1) year after the last date of assignment."

Date

Applicant Signs Upon Visiting Office

Attach Your Resume:

Supplementary Experience Form

Social Security Number

Position(s) applied for (list all)-

Name

Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

Job Title:

Description of Duties:

Salary start

Salary Finish

Dates From:

Dates To:

Full timePart-time

Employer:

Employer Address:

Employer Phone:

Supervisor Name:

Reason for Leaving:

Your name if different from present

11500 Olive Blvd, Suite 158

Saint Louis, MO, 63141

+314-432-7827

info@starresourcehomecare.com

Employment

Employment

Online Employment Application

An Equal Opportunity Employer

EDUCATION

EXPERIENCE

10.REFERENCES

11.MISCELLANEOUS

13.CERTIFICATION: Each Application Requires Current Date and Original Signature

Supplementary Experience Form