Please complete every section carefully. Incomplete applications will not be considered. This apprenticeship offers hands-on training in the senior placement industry with no upfront cost — only motivated individuals ready to take action will be accepted.

Personal Information

First Name *

Last Name *

Cell Phone *

Email *

Address

Street Address *

City *

State *

Postal Code *

Background Information

Are you currently employed in senior living or healthcare? *

YES

NO

Have you ever worked in sales, customer service, or business development? *

YES

NO

If yes, please share details (industry, type of sales, years of experience):

Do you have any direct experience with seniors, caregiving, or assisted living placements? *

YES

NO

If other, please share details:

Goals & Motivation

Why are you interested in becoming a Senior Placement Apprentice? (Short answer – what draws you to this opportunity?) *

What are your short-term (6–12 months) and long-term (3–5 years) financial goals? (Be specific – e.g., “I want to replace my job income,” or “I want to earn $100k+ annually.”) *

How much time per week are you able to dedicate to this apprenticeship program? *

Less than 10 hours

10-20 hours

20-30 hours

Full-time commitment

Do you have reliable transportation and the ability to visit senior communities, hospitals, and skilled nursing facilities? *

Yes

No

Skills & Personality

How comfortable are you with talking to new people, making phone calls, and networking with professionals? (Rate 1–10, 1 = very uncomfortable, 10 = extremely confident) *

Describe one strength that will make you successful in this business: *

Describe one weakness you’d like to improve through this apprenticeship: *

Technology & Tools

Do you have access to a smartphone, computer/laptop, and internet connection? *

Yes

No

Have you ever used CRM or lead management tools (e.g., HubSpot, GoHighLevel, etc.)? *

Yes

No

Are you active on professional platforms such as LinkedIn or Facebook? *

Yes

No

If yes, please share your LinkedIn or Facebook link:

Commitment & Availability

The apprenticeship requires accountability, communication, and consistency. Are you willing to attend weekly coaching calls and complete assignments on time? *

Yes

No

Are you open to a revenue share model, where your first few move-ins contribute toward your program cost (instead of paying upfront)? *

Yes

No

When are you available to start if accepted? *

Immediately

Within 2 weeks

Within 30 days

Final Section

If other, Please explain:

Applicant Declaration

I certify that the information provided is accurate and complete. I understand that submission does not guarantee acceptance into the apprenticeship program. *

Clear

Signature