HomeJob Application Shepherd Premier Senior Living Thank you for your interest in working with our team! Please download and complete the entire application below. Then email a copy of your resume and the application to both maria@shepherdpremierseniorliving.com and theresa@shepherdpremierseniorliving.com Download Job Application Employment Application First Name Last Name Email Date of Birth AddressAddress Line 1 Address Line 2 City State Zip Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePreviousNextDate 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?: PreviousNextAre you a citizen of the United States? Yes NoIn no, are you authorized to work in the U.S.? Yes NoHave you ever worked for this company? Yes NoIf yes, when? Have you ever been convicted of a felony? Yes NoIf yes, explain: Please summarize your Special Skills, Qualifications, Certifications, etc.: PreviousNextEducationHigh School Address: Dates Attended: Did you graduate? Yes NoDiploma? PreviousNextEducation continued. . .College: Address: Dates Attended: Did you graduate?: Yes NoDegree: PreviousNextEducation continued. . .Other Education: Address: Dates Attended: Did you graduate?: Yes NoDegree: PreviousNextReferencesPlease 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: PreviousNextReferences continued. . .Full Name (Reference #2): Relationship: Company: Phone/Mobile Address: PreviousNextReferences continued. . .Full Name (Reference #3): Relationship: Company: Phone: Address: PreviousNextWork HistoryCompany: 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 NoPreviousNextWork 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 NoPreviousNextWork 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 NoPreviousNextMilitary ExperiencePrevious Military Experience: Branch: Start Date of Service: End Date of Service: Rank at Discharge: Type of Discharge: If other than honorable, explain: PreviousNextAdditional QuestionsAs a condition of employment, all employees must be Bondable and Insurable. Are you at least 19 years of age? Yes NoList ALL States and Counties of Residence and Employment for the past 7 years: Have you had any moving traffic violations? Yes NoIf yes, please describe: Have you EVER been charged or convicted of a felony and/or a misdemeanor or served time? Yes NoIf 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 NoIf 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 NoPreviousNextUpload Resume and Cover LetterIf you do not have a resume or cover letter, proceed to the next section.Upload Resume Choose File Upload Cover Letter Choose File PreviousNextCertification of ApplicationI 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.) Previous Submit Form Loading… If the next form question doesn’t appear, hit the TAB key to move forward. Today's Date Full Name Date of Birth Street Address City State Zip Code Phone Email ___________ 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 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 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 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. Signature (type your full name below): Date: Upload Your Resume Submit