Please complete the form below to be considered by Shared Touch, Inc. to an employee. We will review your application and get back to you at our earliest convenience.

It is the Shared Touch, Inc. policy that all persons are entitled to the Equal Employment Opportunity regardless of race, religion, color, sex, age, national origin, disability, or veteran status. If you are applying to becoming part of the Shared Touch, Inc. team you must meet the following requirements:

1. English & Spanish speaking
2. Legally authorized to work in the United States
(Driver License and Social Security Card or other I-9 acceptable documentation)
3. Minimum two (1) years of related work experience or one of the following: C.G, H.M.
4. Provide three (3) employment references
5. Certificate of auto insurance (if applicable).

Last Name (required)

First Name (required)

Birth Date


Address 2



Zip/Postal Code


Telephone (required)


Alternative Telephone


Your Email (required)

Have you ever been convicted of a crime? (required)

Have you ever applied at Shared Touch, Inc. before? (required)

How did you hear about us?

List below all previous work experience including name, address and phone number of previous employers, dates of employment, and job title.

Are you currently employed?

If yes, including name, address and phone number of current employer, hire date, and job title.

How many years at your current address?

What part of town are you in?

Please give a full and detailed description of your work experience as far as job duties including all qualifications and certifications.

Would you be willing to get additional training if needed?

Do you drive a vehicle?


Insurance Carrier:

What is the type of insurance coverage
Full CoverageLiability Coverage

Have you had any vehicle accidents/tickets within the last 5 years?

If yes, explain:

What prompted you to apply to work at Shared Touch, Inc.?

Why do you feel you are a good fit for our company?

Please list at least THREE employer references including their first and last name, company name, email address and phone number.

What, if any other languages do you speak, read and/or write fluently?

What experiences have you had working with behaviorally challenged individuals?

What experiences have you had working with dually diagnosed individuals (example: mentally underdeveloped and mental illness)?

What experiences have you had working with sexually inappropriate behaviors?

Describe the disabilities and/or challenges you believe you are MOST “comfortable” working with.

Describe the disabilities and/or challenges you believe you are LEAST “comfortable” working with.

Are you currently in good physical and mental health? If no, please explain:

Have you ever been involved in a drug treatment program? If yes, please explain:

Do you have any other remarks you’d like for us to know that may be helpful in considering you as an employee?

By typing your name below (required) you acknowledge that you have completed this application to the best of your ability and that the information you have provided on this application is correct and truthful.(required)