Job Application - Shepherd Premier Senior Living

Shepherd Premier Senior Living

Thank you for your interest in working for the Shepherd Premier Senior Living Team.

Please download and complete the entire application below. Then email a copy of your resume and the application to both patti@shepherdresidentialcare.com and michele@shepherdresidentialcare.com

Download Job Application

Employment Application

First Name

Last Name

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Date Available:

Social Security Number:

Desired Pay ($ per hour):

Position Applied For:

Driver's License Number:

Driver's License State:

How were you referred to us?:

Are you a citizen of the United States?

Yes

In no, are you authorized to work in the U.S.?

Yes

Have you ever worked for this company?

Yes

If yes, when?

Have you ever been convicted of a felony?

Yes

If yes, explain:

Please summarize your Special Skills, Qualifications, Certifications, etc.:

Education

High School

Address:

Dates Attended:

Did you graduate?

Yes

Diploma?

Education continued. . .

College:

Address:

Dates Attended:

Did you graduate?:

Yes

Degree:

Education continued. . .

Other Education:

Address:

Dates Attended:

Did you graduate?:

Yes

Degree:

References

Please list three professional references and let them know in advance we will be contacting them. Please do not include relatives. Your application will not be considered unless three references are provided.

Full Name (Reference #1):

Relationship:

Company:

Phone:

Address:

References continued. . .

Full Name (Reference #2):

Relationship:

Company:

Phone/Mobile

Address:

References continued. . .

Full Name (Reference #3):

Relationship:

Company:

Phone:

Address:

Work History

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Employment Start Date:

Employment End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

Work history continued. . .

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Employment Start Date:

Employment End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

Work history continued. . .

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

Employment Start Date:

Employment End Date:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes

Military Experience

Previous Military Experience:

Branch:

Start Date of Service:

End Date of Service:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Additional Questions

As a condition of employment, all employees must be Bondable and Insurable. Are you at least 19 years of age?

Yes

List ALL States and Counties of Residence and Employment for the past 7 years:

Have you had any moving traffic violations?

Yes

If yes, please describe:

Have you EVER been charged or convicted of a felony and/or a misdemeanor or served time?

Yes

If yes, please describe the incident, city & state and charge in full:

Have you EVER been accused, charged, or convicted of any form of abuse, neglect, or theft?

Yes

If yes, please explain in detail:

Have you ever been a charged perpetrator or appeared on any sex offender or child abuse registry in the last 5 years?

Yes

Upload Resume and Cover Letter

If you do not have a resume or cover letter, proceed to the next section.

Upload Resume

Choose File

Upload Cover Letter

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Certification of Application

I certify that my answers are correct and complete, and true to the best of my knowledge and belief. I understand that the use of illegal drugs is prohibited during my employment and that additional testing for the presence of illegal drugs may be required prior to employment and randomly at any time during employment with Shepherd Residential Care Homes. I am willing to submit to drug testing to detect the use of illegal drugs.

I understand that any false or misleading information, omissions, or misrepresentations of facts in my application or interview will result in the rejection of this application or discharge at any time during my employment. I authorize Shepherd to contract with Stateline Investigations to conduct a background check to verify any of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, companies, and law enforcement authorities to release any information concerning my background and hereby release all said persons, companies, and law enforcement agencies from any liability for any damage whatsoever for issuing this information. I release Shepherd companies, Shepherd Capital, and Stateline Investigations from any liability which might result from making such investigations.

If you agree with the above statement, type your full name and the date below:

(Note: This is a large form. After you click "Submit Form," it may take a minute to complete submission. Please do not leave this page until submission is completed.)

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Today's Date

Full Name

Date of Birth

Street Address

City

State

Zip Code

Phone

___________

Date Available

Social Security No.

Desired Pay

Position Applied For

Driver's License Number & State

How Were You Referred to Us?

Are You a Citizen of the United States?

Yes No

If no, are you authorized to work in the U.S.?

Yes No

Have you ever worked for this company?

Yes No

If yes, when?

Have you ever been convicted of a felony?

Yes No

If yes, explain:

Please summarize your Special Skills, Qualifications, Certifications, etc:

___________

Education Information

High School

Address

From:

To:

Did You Graduate?

Yes No

Diploma:

College:

Address

From:

To:

Did You Graduate?

Yes No

Degree:

Other:

Address

From:

To:

Did You Graduate?

Yes No

Degree:

___________

References

Full Name

Relationship:

Company

Phone:

Address:

___________

Full Name

Relationship:

Company

Phone:

Address:

___________

Full Name

Relationship:

Company

Phone:

Address:

___________

Work History

Company:

Phone

Address:

Supervisor

Job Title

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

___________

Company:

Phone

Address:

Supervisor

Job Title

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

___________

Company:

Phone

Address:

Supervisor

Job Title

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

___________

Military Experience

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

___________

As a condition of employment, all employees must be Bondable and Insurable. Are you at least 19 years of age?

Yes No

List ALL States and Counties of Residence and Employment for the past 7 years:

Have you had any moving traffic violations?

Yes No

If yes, please describe:

Have you EVER been charged or convicted of a felony and/or a misdemeanor or served time?

Yes No

If yes, please describe the incident, city & state and charge in full:

Have you EVER been accused, charged or convicted of any form of abuse, neglect or theft?

Yes No

If yes, please explain in detail:

Have you ever been a charged perpetrator or appeared on any sex offender or child abuse registry in the last 5 years?

Yes No

___________

I understand that any false or misleading information, omissions or misrepresentations of facts in my application or interview will result in the rejection of this application or discharge at any time during my employment. I authorize Shepherd to contract with Stateline Investigations to conduct a background check to verify any of this information including, but not limited to, criminal history and motor vehicle driving records.

I authorize all persons, companies and law enforcement authorities to release any information concerning my background and hereby release all said persons, companies and law enforcement agencies from any liability for any damage whatsoever for issuing this information. I release Shepherd companies, Shepherd Capital and Stateline Investigations from any liability which might result from making such investigations.

Signature (type your full name below):

Date:

Upload Your Resume

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224-333-6247

Shepherd Premier Senior Living

Thank you for your interest in working for the Shepherd Premier Senior Living Team.

Employment Application

Education

Education continued. . .

Education continued. . .

References

References continued. . .

References continued. . .

Work History

Work history continued. . .

Work history continued. . .

Military Experience

Additional Questions

Upload Resume and Cover Letter

Certification of Application

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