Allstar Healthcare, Inc.

APPLICATION For Employment

Allstar Healthcare, Inc. considers applicants for all positions without regards to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

APPLICANT INFORMATION:
ALL FIELDS ARE REQUIRED. ENTER "N/A" FOR BLANK FIELDS. YOUR APPLICATION WILL NOT BE COMPLETED UNTIL YOU CLICK THE SUBMIT BUTTON. DO NOT USE THE BACK BUTTON. ALL DATA ENTERED WILL BE LOST.
First Name:
Middle Name:
Last Name:
Address 1:
City:
Sate:
Zip:
Home Phone:
Cell Phone:
E-mail Address:
Social Security Number:
Driver License Number:
Position Applied For:
If you are applying for patient care position, please list ALL areas you are willing to accept patient (e.g.: Tarrant, Dallas, Arlington, Fort-Worth, Plano, Richardson, etc.):

How did you learn about us?	Advertisement Friend Walk-In Relative Staffing Agency
GENERAL INFORMATION:

If you are less than 18 years of age, can you provide required proof of your eligibility to work?	Yes No
Have you ever filed an application with use before?	Yes No
If Yes, when did you apply (date)?
Have you been employed by us before?	Yes No
If Yes, when did you work for us (date)?
Are you currently employed?	Yes No
May we contact your present employer?	Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.)	Yes No
When will you be available to work (date)?

What are you available to work?

Full Time Part Time PRN Shift Work Temporary

Are you currently on "lay-off" status and subject to recall?	Yes No
Can you travel if a job requires it?	Yes No
Have you been convicted of a felony within the last seven years?	Yes No
If Yes, please explain: (A conviction will not neccessary disqualify an applicant from employment)