Contact Us
806-300-0473 (Office)
806-283-4161 (Cell)
806-687-0837 (Fax)
info@jrstarhealthcare.org
7606 University Avenue Suite 1B
Lubbock, Texas 79423




You can print and complete a paper application by clicking here.

All fields with * are required.
First Name: * A value is required.
Last Name: * A value is required.
MI: * A value is required.
Drivers License Number: * A value is required.
Date Of Birth: * A value is required.
SSN: * A value is required.
Current Address: * A value is required.
City: * A value is required.
State: * A value is required.
Zip: * A value is required.
Phone: * A value is required.
E-Mail Address: * A value is required.
How long have you resided at current address? * A value is required.
Prior Address: * A value is required.
City: * A value is required.
State: * A value is required.
Zip: * A value is required.
Phone: * A value is required.
How long did you reside at prior address? * A value is required.
Are you over 18 years of age? *
Are you legally allowed to work in the United States? *



Sex: *




Type of employment desired: *





Have You Worked For This Company In The Past? *



Is so, when? * A value is required.
Names of friends or relatives who presently work for this company: * A value is required.
Emergency Contact Information
Name: * A value is required.
Home Phone: * A value is required.
Work Phone: * A value is required.
Address: * A value is required.
City: * A value is required.
State: * A value is required.
Zip: * A value is required.
How is this person related to you? * A value is required.
Name: * A value is required.
Home Phone: * A value is required.
Work Phone: * A value is required.
Address: * A value is required.
City: * A value is required.
State: * A value is required.
Zip: * A value is required.
How is this person related to you? * A value is required.
Position Desired
Position: * A value is required.
Date you can start work: * A value is required.
Are you currently employed? *



If so, may we contact your current employer? *



Employment History
Company: * A value is required.
Address: * A value is required.
Phone: * A value is required.
Supervisor: * A value is required.
Dates of employment: * A value is required.
Position(s) held: * A value is required.
Starting salary: * A value is required.
Ending salary: * A value is required.
Reason for leaving: * A value is required.
Responsibilities: * A value is required.
Company: * A value is required.
Address: * A value is required.
Phone: * A value is required.
Supervisor: * A value is required.
Dates of employment: * A value is required.
Position(s) held: * A value is required.
Starting salary: * A value is required.
Ending salary: * A value is required.
Reason for leaving: * A value is required.
Responsibilities * A value is required.
Company: * A value is required.
Address: * A value is required.
Phone: * A value is required.
Supervisor: * A value is required.
Dates of employment: * A value is required.
Position(s) held: * A value is required.
Starting salary: * A value is required.
Ending salary: * A value is required.
Reason for leaving: * A value is required.
Responsibilities * A value is required.
Educational Background
Name and Address: * A value is required.
Years Completed: * A value is required.
Did you graduate? *



Major/Degree: * A value is required.
Name and Address: * A value is required.
Years Completed: * A value is required.
Did you graduate? *



Major/Degree: * A value is required.
Name and Address: * A value is required.
Years Completed: * A value is required.
Did you graduate? *



Major/Degree: * A value is required.
Languages and Skills
Language 1 * A value is required.
Minimal Fluent Read Write
Language 2 * A value is required.
Minimal Fluent Read Write
Language 3 * A value is required.
Minimal Fluent Read Write
List any special skills you have that can be applied to this position: * A value is required.
Security
Have you ever been bonded? *



If so, explain: * A value is required.
Have you been convicted of a felony within the past 5 years? *



If so, explain (this will not necessarily exclude you from consideration): * A value is required.
Military
Have you served in the military? *



Branch: * A value is required.
Beginning and Ending Dates: * A value is required.
Rank: * A value is required.
Do you have any military commitment, including National Guard service that would influence your work schedule? *



If so, explain: * A value is required.
Are you a Vietnam veteran? *



Are you a disabled veteran? *



Are you a special disabled veteran? *



Reasonable Accomodations: In the event you believe you will need reasonable accomodations to assist you in performing your job, please contact your supervisor or human resources coordinator.
By submitting this application you certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application will be grounds for dismissal.

(Please check your fields carefully. This form will not send without the all fields completed.)

 

CONTACT
806-300-0473 (Office)
806-283-4161 (Cell)
806-687-0837 (Fax) info@jrstarhealthcare.org 7606 University Avenue
Suite 1B
Lubbock, TX 79423
APPLY NOW
We hire the best RN’s, LVN’s and CNA’s for positions with local medical centers. Click here to apply online or print and application.
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We provide the best medical staff in the business on demand. Click Here to contact us regarding staffing services.