Apply to the Network – Easy Senior Move Partner Network

Step 1 of 9

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Section 1: Basic Information

Full Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

The best email address to reach you.

Company Name(Required)

Title / Role(Required)

Phone(Required)

Direct phone--best number to reach you.

Business Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Section 2: Production & Experience

Service Category (select one)(Required)

Senior Living Placement (Assisted Living, Memory Care, Skilled Nursing, Independent Living)

Real Estate Agent / Broker

Real Estate Investor / Wholesaler

Estate / Probate Attorney

Home Health / In-Home Care

Estate Sale / Clean-Out Service

Contractor (Home Modifications / Repairs)

Case Manager / Geriatric Care Manager

Other

Other Service Category (specify)

Specialty Areas (check all that apply)

Probate / Estate Properties

Reverse Mortgage Situations

Medicaid Spend-Down / Asset Planning

Memory Care / Dementia Specialization

Hospice / End-of-Life Coordination

Veterans Aid & Assistance / Disability and Benefits applications

Out-of-State Family / Long-Distance Caregivers

Distress / Time-Sensitive Property Sales

Other

Years in Business(Required)

Number of Clients Served in the last 12 months.(Required)

Number of listing/seller rep transactions completed in the last 12 months (real estate)

Number of seller rep transactions completed in the last 12 months (real estate)(Required)

Other Specialty Area (specify)

Service Area (zip codes / counties)

Section 3: Quality, Reputation & Verification

A minimum of three (3) client references from within the past 18 months is required. References, licenses, and credentials will be verified prior to approval and on an ongoing basis.

Client/Customer Reference #1 — Name(Required)

Reference #1 — Phone(Required)

Reference #1 — Email(Required)

Reference #1 — Type of service provided(Required)

Reference #1 — Approximate date of service(Required)

MM slash DD slash YYYY

Client/Customer Reference #2 — Name

Reference #2 — Phone

Reference #2 — Email

Reference #2 — Type of service provided

Reference #2 — Approximate date of service

MM slash DD slash YYYY

Reference #3 — Name

Reference #3 — Phone

Reference #3 — Email

Reference #3 — Type of service provided(Required)

Reference #3 — Approximate date of service(Required)

MM slash DD slash YYYY

Online Presence & Reputation

Please complete all that apply.

Website URL

Business Email

Domain-based business email not a Gmail/Yahoo/Hotmail, etc.

Business Email

I do not have a business email.

Google Business Profile URL

Yelp / Industry-Specific Review Page URL

LinkedIn Profile URL

Facebook Business Page

Licensing and Creditials

License Number (if applicable)

License Issuing Authority

Have you ever had a license suspended, revoked, or subject to disciplinary action?(Required)

Yes

If yes, please provide a brief explanation.

Are you currently a party to any active lawsuit, regulatory complaint, or pending investigation related to your business?(Required)

Yes

If yes, please provide a brief explanation.

Upload: Current license(s) / certification(s)

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 512 MB.

Upload current license or certification documents.

Upload: Proof of current liability insurance (if applicable)

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 512 MB.

Upload: E&O insurance (real estate, attorneys)

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 512 MB.

Verification Acknowledgment(Required)

I understand that all credentials, licenses, and references will be verified prior to approval and on an ongoing basis.

Section 4: Operational Fit

ESM operates a structured, accountable network. Partners must agree to the following operational requirements.

Can you respond to referrals within 24 business hours?(Required)

Yes

Can you provide biweekly case updates through the ESM partner portal?(Required)

Yes

Are you comfortable being tracked for response time, case outcomes, and client satisfaction?(Required)

Yes

Are you willing to operate within ESM's designated CRM system for all referrals and case updates?(Required)

Yes

Section 5: Interview and Background Check Requirements

By checking the following acknowledgments, you confirm you have read and agree to ESM's required professional standards. Failure to meet these standards may result in removal from the partner network.

Acknowledgment(Required)

I agree to participate in a recorded interview conducted via Zoom (video required).

Acknowledgment(Required)

I understand all interviews are recorded for quality assurance and training purposes.

Acknowledgment(Required)

I confirm I am accessible by phone during standard business hours (Monday–Friday, 9am–5pm CT).

Acknowledgment(Required)

I acknowledge that referral compensation terms will be disclosed in the Partner Agreement and that I will sign the agreement prior to receiving any referrals.

Section 6: Background Check Authorization

All approved partners must pass a third-party background check before receiving referrals. The information below will be transmitted to a secure screening provider (Checkr, GoodHire, or equivalent). It will not be retained by ESM beyond the verification period.

Full Legal Name (as it appears on government-issued ID)(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Last 4 digits of SSN(Required)

Full SSN will be collected separately via secure provider link.

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Previous Address 1 (last 5 years)

Previous Address 2 (last 5 years)

Previous Address 3 (last 5 years)

Background Check Acknowledgment(Required)

I authorize Easy Senior Move to conduct a background check for the purpose of evaluating my eligibility for partnership.

Background Check Acknowledgment(Required)

I understand the screening may include criminal history (county, state, federal), sex offender registry, civil litigation history, identity verification, and license verification.

Background Check Acknowledgment(Required)

I understand that approval is contingent upon satisfactory results, as determined at the sole discretion of Easy Senior Move.

Background Check Acknowledgment(Required)

I understand that misrepresentation of any information on this application is grounds for automatic disqualification or immediate removal from the network.

Section 7: Applicant Certification & Signature

Applicant Certification(Required)

I certify that all information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation is grounds for rejection or, if discovered after acceptance, immediate removal from the partner network. I authorize Easy Senior Move to verify all information provided, including contacting references, verifying licenses, and conducting a background check.

Signature(Required)

Print Name(Required)

Date(Required)

MM slash DD slash YYYY

Join the Vetted Partner Network.

Partner Application

Section 1: Basic Information

Section 2: Production & Experience

Section 3: Quality, Reputation & Verification

Online Presence & Reputation

Licensing and Creditials

Section 4: Operational Fit

Section 5: Interview and Background Check Requirements

Section 6: Background Check Authorization

Section 7: Applicant Certification & Signature