STAR Services | Employment Application

Name * First Last

Address *

Street Address City State / Province Postal / Zip Code Country

Email *

Primary Phone * ### - ### - ####

Work/Alternate Phone ### - ### - ####

Are you legally eligible for employment in the US? *

Yes No

Are you 18 years of age or older? *

Yes No

Referred by:

Have you ever applied for a position with STAR Services before? *

Yes No

Prior Application Date: MM / DD / YYYY Pick a date.

Have you ever worked for STAR Services before? *

Yes No

Last Date of Employment: MM / DD / YYYY Pick a date.

Do you currently, or have you ever, worked for Cooperating Community Programs (CCP) or any of its affiliates? *

Yes No

If yes, why did you leave?

AVAILABILITY:

What position are you applying for? *

What date can you start? *

Select one: *

Full Time Part Time Temporary

Shift Availability

Select Day/Shift ONLY if you are available for the ENTIRE shift time listed!

First Shift: 7am-3pm *

Select all that apply.

Second Shift: 3pm-10pm *

Select all that apply.

Overnight: 10pm-7am *

Select all that apply.

Please note: In order to optimize your employment opportunities, STAR may submit your application to other providers if there are no current openings at STAR. Please check the box if you DO NOT want us to share your application with other prospective employers.

Can you accept a position that requires:

Driver's License? *

Yes No

Use of your vehicle? *

Yes No

Do you have any accommodation needs which may require adaptation of job duties, tasks, or work environment? *

Yes No

If yes, please describe such needs and explain how you can perform the job with the accommodation.

EDUCATION:

High School

School Name/Address - High School

Years Completed - High School

1 2 3 4

Did you graduate high school?

Yes No

Course of Study - High School

College

School Name/Address - College

Years Completed - College

1 2 3 4

Did you graduate college?

Yes No

Course of Study - College

Other

School Name/Address - Other

Did you graduate?

Yes No

Course of Study - Other

Do you have other relevant experience, skills, or qualifications?

EMPLOYMENT RECORD:

Begin with your present or most recent employer.

Employer 1 *

Address - Employer 1

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Phone - Employer 1 ### - ### - ####

Supervisor Name/Title - Employer 1

Position Title - Employer 1

Duties Performed - Employer 1

Employment Dates (START DATE/END DATE) - Employer 1

Ending Wage - Employer 1

Reason for Leaving - Employer 1

Employer 2

Address - Employer 2

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Phone - Employer 2 ### - ### - ####

Supervisor Name/Title - Employer 2

Position Title - Employer 2

Duties Performed - Employer 2

Employment Dates (START DATE/END DATE) - Employer 2

Ending Wage - Employer 2

Reason for Leaving - Employer 2

Employer 3

Address - Employer 3

Street Address Address Line 2 City State / Province Postal / Zip Code Country

Phone - Employer 3 ### - ### - ####

Supervisor Name/Title - Employer 3

Position Title - Employer 3

Duties Performed - Employer 3

Employment Dates (START DATE/END DATE) - Employer 3

Ending Wage - Employer 3

Reason for Leaving - Employer 3

PROFESSIONAL REFERENCES:

Minimum of two references

Name/Title - Reference 1 *

Address - Reference 1

Street Address City State / Province Postal / Zip Code Country

Phone - Reference 1 ### - ### - ####

Email - Reference 1

Name/Title - Reference 2 *

Address - Reference 2

Street Address City State / Province Postal / Zip Code Country

Phone - Reference 2 ### - ### - ####

Email - Reference 2

Name/Title - Reference 3

Address - Reference 3

Street Address City State / Province Postal / Zip Code Country

Phone - Reference 3 ### - ### - ####

Email - Reference 3

ANSWER THE FOLLOWING QUESTIONS:

REQUIRED

Consider a time when you provided excellent customer service. Describe the quality or trait that made the service excellent. *

Provide an example of what it means to be a team player. *

IMPORTANT, PLEASE READ:

By submitting this application for employment, I hereby affirm that all statements are accurate, complete, and true to the best of my knowledge. I understanding that if I knowingly give false information, I will not be eligible for employment with this agency. I authorize any person, school, current and past employer, and organizations named in this application to provide this agency with any information connected with this application, and I release such persons and organizations from any legal liability in making such statements. I understand that a background check may include an internet search. In addition, I acknowledge that any time during employment, a physical, mental, health, chemical dependency, motor vehicle report, or background study through DHS may be required if there is reasonable cause to believe the qualification requirements have not been met, or that they employee cannot provide the required care for the consumer(s). Failure to comply with any of these requirements will result in immediate separation from employment with this agency.

I understand that nothing in this application or any prior or subsequent written or oral statement creates a contract of employment or any rights in the nature of a contract. I agree and understand that if I am hired by STAR Services, Inc., my employment will be "at will", for an indefinite period of time, and may be terminated at any time, with or without case or notice, at the option of STAR Services, Inc. or myself.

I also understand that no one has the authority to enter into any contract, agreement, or modification of the foregoing, unless such a contract, agreement, or modification is in writing and signed by Kathy Shroyer, CEO.

STAR Services, Inc. is fully committed to Equal Employment Opportunity and to attracting, retaining, developing, and promiting the most qualified employees without regard to their race, gender, color, religion, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, or any other characteristic prohibited by state or local law. We are dedicated to providing a work environment free from discrimination and harassment, and where employees are treated with respect and dignity. When a conflict occurs, the company promptly addresses the matter. Should an employee feel they have been unfairly treated, they should report the matter to their Human Resources Representative or Kathy Shroyer, CEO.

Application for Employment

AVAILABILITY:

Shift Availability

EDUCATION:

EMPLOYMENT RECORD:

PROFESSIONAL REFERENCES:

ANSWER THE FOLLOWING QUESTIONS:

IMPORTANT, PLEASE READ: