• MORNING STAR HOME CARE

  • APPLICATION FOR EMPLOYMENT

  • All prospective employees will receive consideration without discrimination because of race, color, creed, age, national origin, or disability. All information provided herein will be kept confidential.

  • PERSONAL INFORMATION

  • Date of Birth:*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Have you ever applied for employment with this Agency?*
  • Are you legally eligible for employment in the United States?*
  • Proof of eligibility will be required upon hire.
  • How did you learn about our agency?*
  • Are you willing to work:*
  • Rows
  • Position Applying For:*
  • Copyright 2017@Morning Star Home Care. Revised 2025
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  • EDUCATION

  • Rows

  • EMPLOYMENT HISTORY (List the last five years of employment history, starting with the most recent employer.)

  • From:*
     - -
  • To:*
     - -
  • From:
     - -
  • To:
     - -
  • From:
     - -
  • To:
     - -
  • Copyright 2017@Morning Star Home Care. Revised 2025
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  • Was your last name different from your present name during any of these jobs?*
  • Are you currently employed?*
  • Do you have reliable transportation?*

  • PROFESSIONAL REFERENCES

  • Please provide at least three professional references who have supervised you, worked with you, or can speak to your job performance, attendance, reliability, and caregiving skills. References may include former employers, supervisors, coworkers, clients, or volunteer coordinators. Family members and personal friends are not acceptable references.

  • GENERAL INFORMATION

  • I understand that employment is contingent upon successful completion of a criminal background check, Connecticut DSS Administrative Action List check, and OIG Exclusion List check as required by Connecticut law.
  • Have you been convicted of a crime in the past five years barring employment in a Home Care and Community Support Agency?*
  • (Conviction will not necessarily disqualify an applicant from employment.)
  • Have you ever been convicted of a crime involving violence or dishonesty in a state or federal court or been subject to disciplinary action by a licensing agency?*
  • Are you capable of performing the job as described in the job description?*
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  • I understand that I must immediately report suspected abuse, neglect, or exploitation of clients, as required
    under Connecticut law.
  • If hired, I agree to comply with HIPAA and all agency confidentiality policies.

  • CERTIFICATION AND AGREEMENT

  • I certify that the facts contained in this application are true and complete to the best of my knowledge. I
    understand that if employed, falsified statements on this application shall be grounds for dismissal.
  • I authorize a complete investigation of all statements contained herein and give my full permission for
    Morning Star Home Care to contact and discuss my background and history with all persons and entities
    listed above. I release all former employers and others listed above from all liability for any damages that
    may result from furnishing this information to Morning Star Home Care.
  • I understand and agree that, if hired, my employment is for no definite period and may be terminated at any
    time for any lawful reason, without prior notice and with or without cause. This agency is not bound by any
    contract unless in writing and signed by the Agency Administrator.
  • This application for employment shall be considered active for 45 days. Applicants wishing to be considered
    for employment beyond this period should inquire about whether applications are accepted.
  • Date:*
     - -

  • EMERGENCY CONTACT INFORMATION

  • Emergency Contact 1

  • Format: (000) 000-0000.

  • Emergency Contact 2

  • Format: (000) 000-0000.
  • Copyright 2017@Morning Star Home Care. Revised 2025
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  • Should be Empty: