Five Star Healthcare Services, Inc.

Employee Onboarding Paperwork

Complete your employment application, acknowledgements, and required documents online. Everything is submitted securely to our office — no printing or faxing needed.

Applicant information

First name *Middle name Last name *Other name used in employment Email *Home phone Business phone Position desired *Street address *City *State *ZIP code *

Available

Shifts willing to work

Eligibility & credentials

Never enter your full Social Security number here — upload a photo of your card in step 6 instead.

Legally eligible to work in the U.S.A.? *

If on a visa, what type? State license # License expiration date Driver's license # Health card expiration CPR card expiration ACLS certification date

Have you ever been convicted of a crime?

Conviction of a crime is not an automatic bar to employment; other factors such as the nature of the crime will be taken into consideration.

Education

Type of school Name & location Major Degree & date

Work experience

From To Employer & full address Type of business Position held Supervisor & title Work phone Starting pay Final pay Reason for job change Duties / responsibilities

References

Reference #1

Name Phone number Personal / work related

Reference #2

Name Phone number Personal / work related

Required documents

Attach a photo or PDF of each item. Federal forms (W-4, I-9) can be downloaded, signed, and uploaded here. Files are stored privately and only visible to our office.

Driver's license or photo ID

Upload

Social Security card

Upload

CPR card

Upload

Health card / TB test

Upload

Professional license or certification

Upload

Signed W-4

Upload

Signed I-9

Upload

Resume (optional)

Upload

Acknowledgements & signature

Please read each statement, then type your full name to sign.

DPS Criminal History (CCH) verification. I acknowledge that a Computerized Criminal History check may be performed by accessing the Texas Department of Public Safety secure website, based on name and date-of-birth identifiers. I understand a fingerprint search may also be requested to clear any misidentification.Orientation statement. I have read, understand, and will comply with all applicable agency policies and procedures during the orientation process of this agency.Job description & physical requirements. I have read and understand the duties, qualifications, and physical requirements of the position — including standing and walking for the majority of a shift, lifting and carrying up to 30 pounds, and pushing or pulling while transferring clients.Equal opportunity & accuracy. Five Star Healthcare Services, Inc. is an equal opportunity employer and does not discriminate on the basis of race, color, gender, religion, national origin, age, sexual orientation, disability, or veteran status. I certify that the information I have provided is true and complete.

Type your full name to sign *This acts as your signature.Date Anything else we should know?

Questions? Call our office at (281) 313-0504