Application - GoldStar Vascular Access

Online Employment Application

Welcome and thank you for your interest in employment in GOLDSTAR VASCULAR ACCESS, INC. Before beginning your application, you will need to have detailed Information regarding your credentials, Employment History, Professional References and Education. You have to complete the entire application in one session. Please take the time to enter as accurate and complete information as possible. Upon completion of your application, a recruiter will contact you to discuss your interest and the shifts/contracts that are available.

If you think you made a mistake after form is submitted, send us email to info@goldstarpicc.com with your full name and proper correction.

Thank you

_{ps: Use of big screen is recommended to get best experience filling out}

Tabulated mode Flat mode

Title *

Personal Information

Info

First Name *

Last Name *

Middle Initial

Maiden Name

Birthdate

Address

	Type	Address	City	State	Zipcode
1
1

Add Address

Contact Information

Please supply a minimum of two contact ways on how we can get a hold of you (not including emergency contacts).
*Phone number and email address are preferred.
Note: You will not be able to submit the application unless this information is added.

Contacts

	Type	Contact	Note
1
2
1

Add new contact

Emergency Contact

	Name	Phone Number	Relation
1
1

Add new contact

Specialties

Specialties information

Please select specialties for the clinical areas that you have worked in within the last 3 years

	Name \| Description
1
1

Add Row

Credentials

Credential information

Please provide all Credential information that you have available.
Make sure to include any files or documents associated with the credential information you have supplied. (CPR card, License, etc.)
*note: Supported files format are PDF, JPG, PNG, DOC, DOCX.

	Name \| Description	Expiration Date	File
1			File name: File size:
1			File name: File size:

Add Row

Attachments

Additional Attachments

Please upload any additional files or documents you would like to include with this application (Resume, Cover letter, etc.)
*note: Supported files format are PDF, JPG, PNG, DOC, DOCX.

	Name	Attachment Type	File
1			File name: File size:
1			File name: File size:

Add new Attachment

Employment History

Starting with you most recent employment, please provide a complete employment history for the past 7 years

Professional References

Please provide contact information for those capable of evaluating your professional abilities. In an effort to complete your application process, please provide an email address or a telephone number with each reference. [ 2 Required]

Reference Contact

Name: *	Title: *	Employer: *	Phone Number:	Email Address

Reference Contact

Name: *	Title: *	Employer: *	Phone Number:	Email Address

Reference Contact

Name: *	Title: *	Employer: *	Phone Number:	Email Address

Add Professional Reference

Education

Education Information

Please provide all high school and higher education resources

1	School Information School Name: * City * State Degree: * Major/Field of Study: * Current Status: Graduated Attending Expected / Graduation Date: *
1	School Information School Name: * City * State Degree: * Major/Field of Study: * Current Status: Graduated Attending Expected / Graduation Date: *

Add an Education Entry

Questionnaire

Please take a moment to complete this questionnaire.

Terms and Conditions

Please read the following statement prior to submitting your information with GoldStar Vascular Access Inc. You will be asked to agree to this statement when submitting your online application. If you have any questions regarding the following statement, please contact GoldStar Vascular Access Administration.

I hereby certify that the information contained in this application I submit to GoldStar Vascular Access is true and complete to the best of my knowledge. I understand that material omissions or falsification of this application in any detail may result in my disqualification from being considered for this position. *

AgreeDisagree

I also understand that this collaboration is subject to a satisfactory check of references. I give GoldStar Vascular Access the right to investigate the information given and to secure additional information if necessary. I authorize my previous employers, educational institutions and all other individuals and organizations listed in this application form to give information about my employment, work habits and character. *

AgreeDisagree

I agree that GoldStar Vascular Access and my previous employers, educational institutions and all other individuals and organizations listed in this application will not be held liable in any respect if an employment offer is not made, is withdrawn, or my employment is terminated because of misrepresentations or omission of the requested information. *

AgreeDisagree

I understand that upon offer and acceptance of a position with GoldStar Vascular Access I will be required to immediately furnish documentation establishing my identity and eligibility to be legally employed in the United States. *

AgreeDisagree

I understand that GoldStar Vascular Access is in no way obligated to provide employment and also that I am in no way obligated to accept employment if offered. This application does not bind either party, and the statements contained herein do not constitute and should not be interpreted to constitute any sort of contract or employment. *

AgreeDisagree

Verify that you are a human *

Submitting...

Online Employment Application

Personal Information

Contact Information

Specialties information

Credential information

Additional Attachments

Employment History

Professional References

Education Information

Questionnaire

Terms and Conditions

What we stand by

GoldStar Vascular Access, Inc.

1	Job Information Facility Information Name: * Employment type: Permanent Per Diem Travel Internship Self-employment Address 1: Address 2: City: State: Zip: Supervisor Information Name: Phone Ext: Email: Can Contact: YesNo Authorize us to contact this supervisor Employment Start Date: * End Date Current position YesNo Job Description Job Title Unit / Desc: Job Desc: Reason For Leaving
1	Job Information Facility Information Name: * Employment type: Permanent Per Diem Travel Internship Self-employment Address 1: Address 2: City: State: Zip: Supervisor Information Name: Phone Ext: Email: Can Contact: YesNo Authorize us to contact this supervisor Employment Start Date: * End Date Current position YesNo Job Description Job Title Unit / Desc: Job Desc: Reason For Leaving