Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Okikiola Lauran Hunter
Created: 01/03/2020
Other names under which employment may be verified:  
Updated: March 18, 2020

Home Address
Street Address
770 Pahl Rd
Unit/Suite Number
City ST/Zip
Elk Grove Village, IL 60007
Home Phone
2243815386
Mobile Phone
2244210827
Alternate Phone
2243815386

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.  
Do you have a valid driver’s license?   Yes
Do you have access to a car? Yes

I am able to work client who has or lives with:
Family
Yes
Hospice
Yes
Cats
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Home Instead

How many years have you worked as a professional caregiver?  100
What percent of your previous case work has been for an agency?  55
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I’m flexible, dependable and had years of caregiving and hospice experience.

Please share one or more personal or professional experiences you have had as a caregiver.

I order the DME for my clients through Tap Cloud App and also communicate with the rest of the hospice care team to render appropriate care for my patients.

Availability

Days   Yes
Nights   No
Weekdays   Yes
Weekends   No
Live-in   No
Can you travel outside the city of Chicago to work?   Yes

Education

High School   Truman
Location:   IL
Did you graduate?   Yes
Subjects Studied   Science

College   Robert Morris
Location:   IL
Did you graduate?   Yes
Degree:   Healthcare Mgt

Other:   
Location:   IL
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
Nursing

Military Service

U.S. Military or Naval Service   No
Military branch and rank at discharge:   

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Hou
Phone
2393162988
Address

3582 45 th Ave
Naples, Fl

Supervisor
Eleanor Hou
Job Title
Hospice
Salary or Rate of Pay
$17
Responsibilities
Liased between family and care facility
From
02/04/2013
To
05/13/2015
Reason for Leaving
Relocations
May we contact this employer?  Yes

Company Name
Home Instead
Phone
8476908925
Address

450 E Higgins Rd
Elk Grove Village, Il 60007

Supervisor
Alina Emerill
Job Title
Caregiver
Salary or Rate of Pay
$12
Responsibilities
Coordinate care for elderly
From
11/19/2018
To
01/06/2020
Reason for Leaving
Relocating
May we contact this employer?  Yes

 

REFERENCES & ACCEPTANCE

Thank you for entering your employment history in Part Two. Before proceeding, could you please explain any gaps in your work history.
None
Character References
Please provide the names and contact information for three persons, not related to you, whom you have known for at least one year.
Name
Eleanor Hou
Phone
2393162988
Address
Naples, Fl
Relationship
Colleague

Name
Erica Crenshaw
Phone
3312459862
Address
Elgin
Relationship
Colleague

Name
Babbar
Phone
7087170766
Address
Texas
Relationship
Colleague
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.
No additional notes provided.
Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
None
Additional Certifications
No additional certifications or licenses provided.

Have any of your certifications or licenses been suspended or revoked?  No
If yes, explain.  
Resume Upload (optional)
If hired, would you be able to provide a copy of your Social Security Card?* (IDPH requirement)
Yes

I certify that the information contained in this application is true and correct to the best of my knowledge and I understand that falsification of this information is grounds for refusal to hire, or if hired, termination of my employment.

I agree that my employment is at-will and may be terminated or an offer of employment may be withdrawn by Water Tower Nursing and Home Care, Inc. (WTN) at any time, with or without notice, and for any lawful reason.

I understand that as a condition of employment and for continued employment, WTN may require periodic drug testing. I understand WTN will use the information gathered on this employment application to conduct background checking and will contact my references and agree to such references giving WTN any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise. I hereby release WTN, its shareholders, officers, directors, employees and agents from any an all liability for any damage that may result from the collection or utilization of such information in connection with evaluating my potential employment.

I understand if hired, I will be required to produce documentary evidence proving that I am currently authorized to work in the United States. I understand my continued employment is contingent upon providing proof of continuing work authorization upon expiration of any documents provided at time of hire. I understand I will have to provide a copy of my Social Security card upon hire as required by the Illinois Department of Public Health (IDPH).

I understand and agree that no representative of WTN has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to foregoing, unless it is in writing and signed by WTN’s President.

Accepted by
Okikiola “Kiki” Hunter

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
March 16, 2020
This application has been submitted and can no longer be edited.