Careers - All Star Care Agency LLC

Position Applying for:

Hours of Availability:

Day Shift Only

Night Shift Only

Open To Any Shift

Availability Days

Name *

First

Middle Name

Last *

Last

Date of Birth

Social Security Number *

Marital Status

Married

Single

Gender

Female

Male

Other

Do you have an insured automobile?

Yes

No

Address *

Address

City

State/Province

Zip/Postal

Email *

Home phone number

Mobile Phone *

Emergency Contact

In case of emergency, please notify: Full Name

Phone Number

Cell Phone Number

Email Address

Education

School attended

Starts Date

End Date

Address

City

State/Province

Zip/Postal

Additional Professional Training: Name of Program

Employment History 1

Company/Client’s Name:

Job Title:

Start Date

End Date

Ending Pay

Supervisor:

Phone Number

Address

City

State/Province

Zip/Postal

Reason for leaving

Employment History 2

Company/Client’s Name:

Job Title:

Start Date

End Date

Ending Pay

Supervisor:

Phone Number

Address

City

State/Province

Zip/Postal

Reason for leaving

Employment History 3

Company/Client’s Name:

Job Title:

Start Date

End Date

Ending Pay

Supervisor:

Phone Number

Address

City

State/Province

Zip/Postal

Country

Reason for leaving

Employment Reference

Reference 1 - Name/ Company/Email Address/Phone

Reference 2 - Name/ Company/Email Address/Phone

Character Reference

Reference 1 - Name/ Company/Email Address/Phone

Reference 2 - Name/ Company/Email Address/Phone

I authorize AllStar Care Agency to contact my reference

Yes

No

PPD TEST *

I confirm that I have voluntarily taken the PPD test intradermally as a screening method for tuberculosis. I understand that a PPD test must be administered and read annually. Alternatively, a chest Xray must be done every 5 years as a prerequisite for employment at AllStar Care Agency. I release AllStar Care Agency of any liability.

I confirm that I have not voluntarily taken the PPD test intradermally as a screening method for tuberculosis. I understand that a PPD test must be administered and read annually. Alternatively, a chest Xray must be done every 5 years as a prerequisite for employment at AllStar Care Agency. I release AllStar Care Agency of any liability.

Universal Precautions *

I am aware and understand that due to my occupation, I am at risk and exposed to blood and other potentially infectious materials. Therefore, I have researched and have knowledge of OSHA regulations and requirements. I also understand that I am aware of Universal Precautions and know that as a requirement of my job, I will practice Universal Precautions.

Hepatitis B Vaccine Declination *

I understand that due to my occupational exposure to blood and other potentially infectious materials, I may be at risk of acquiring Hepatitis B Virus (HBV). AllStar Care Agency strongly advises me to be vaccinated for HBV. I understand that I may decline vaccination and I also understand that not being vaccinated with the HBV vaccine, I continue at my own risk for acquiring and remain susceptible to HBV.

COVID-19 Declarations *

I affirm that I will follow COVID-19 CDC Guidelines always in the performance of my duties anytime I am required to perform services at a client’s place of residence. I also affirm that, in the last 14 days, i) I have not experienced Fever (temperatures 100 degrees Fahrenheit and over), cough, shortness of breath or difficulty breathing, sore throat, new loss of tase or smell, chills, head or muscle aches, nausea, diarrhea, and vomiting; ii) I have not been in close proximity to anyone who has experienced any of the above symptoms (in (i) above); iii) have not been not close proximity to anyone who has tested positive for COVID-19; (iv) have not tested positive for COVID 19 or is presumptively positive for COVID-19 based on my health care provider’s assessment of my symptoms; v) have not been on a commercial flight or travelled outside of the United States; vi) have not been in close proximity to anyone who has been on a commercial flight or travelled outside the United States. If I feel I am at a high risk of contracting COVID-19 despite following the State Governor’s mandate and CDC Guidelines regarding COVID-19 by entering a facility or a client’s place of residence, I will notify AllStar Care Agency immediately. I understand that AllStar Care Agency requires me to wear a face mask at all times when working at a client’s residence or is with a client, and to follow CDC Guidelines on COVID-19 always.

Click on the button to access finger print form:

Criminal Justice Information Systems form

Authorization for background check: *

I hereby authorize AllStar Care Agency to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that AllStar Care Agency will utilize an outside firm(s) to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company’s choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.

I consent that the above information given are true to the best of my knowledge

Clear

Attach Resume

Maximum upload size: 516MB

Please submit the application below to be considered for a position as a caregiver.

Emergency Contact

Education

Employment History 1

Employment History 2

Employment History 3

Employment Reference

Character Reference