Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Gloria Santos Talapian
Created: 01/06/2020
Other names under which employment may be verified:  
Updated: January 6, 2020

Home Address
Street Address
327-Ashland Avenue
Unit/Suite Number
City ST/Zip
Evanston, IL 60202
Home Phone
None
Mobile Phone
1-708-546-9007
Alternate Phone
None

Have you ever worked for us before?   No
If no, how did you hear about us? Thru my friend who had been my co-worker before.
Rate of pay desired.   $15.00
Do you have a valid driver’s license?   No
Do you have access to a car? No

I am able to work client who has or lives with:
Family
Yes
Hospice
Yes
Cats
No
Dogs
Yes
Smoker
No
What languages do you speak?   
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Advancare and Custom Home Care

How many years have you worked as a professional caregiver?  7
What percent of your previous case work has been for an agency?  99
Please explain how you will contribute to strengthen the Water Tower Nursing team.

To cooperate , unity, willingness and support to the team. Dedication of services at work and always have a communication to the team.

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

As my 7 years experienced at work with different clients I have learned a lot not only my trainings even with the people I care. Giving them respect, understanding, patient at all time with old people and make them comfortable.I love taking care old people.

I am very thankful for the trust they had given me to work with them. I’ve been working to an old woman for 5 years sad she was died and I ‘ m only the caregiver that stayed with her and she treated me like a daughter we shared a lots as her companions.

Availability

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

Education

High School   Infant Jesus Academy
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   

College   Philippine Christian University
Location:   Manila, Philippines
Did you graduate?   Yes
Degree:   Business Administration

Other:   
Location:   
Did you graduate?    Yes
Degree:   

Special awards you earned or courses you have taken.

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Custom Home Care
Phone
773-561-4663
Address

2716 W. Peterson
Chicago, IL 60659

Supervisor
Shaun ( as we call him)
Job Title
Caregiver
Salary or Rate of Pay
$13.00
Responsibilities
Companionship, giving medicine, bath, preparing meals, cleaning, laundry, company to doctors appointment, buying supplies and some groceries if needed, change beddings and company to some of activities in the facilities.
From
07/30/2014
To
01/07/2020
Reason for Leaving
I’ m still working with them until now
May we contact this employer?  Yes

Company Name
Advancare Healthcare Services
Phone
708-392-2000
Address

2625 Butterfield Road # 304s
Oak Brook IL 60523

Supervisor
Sonia (as we call her) forgot her surname
Job Title
Caregiver
Salary or Rate of Pay
$8.50
Responsibilities
Work on the floor giving medicines to the clients in the facilities. One on one taking care a patients, companionships, giving bath and assisting in all their needs, laundry and cleaning.
From
06/06/2013
To
07/25/2014
Reason for Leaving
My husband was transferred church assignment and the place is far with us now.
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.
So far both agencies that I have been work is good to me. But I need to look for another coz the salary that I had been receiving is not sufficient to our needs.
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
Anne Macdonald
Phone
773-525-1202
Address
3121 N. Sheridan Road Chicago, IL 60657
Relationship
Client

Name
Lolita Flores
Phone
708-856-1300
Address
5343 W 35th St. Cicero IL 60804
Relationship
Church friend

Name
July Hobbs
Phone
801-707-6246
Address
8325 Southwood St. Midvale Utah 84047
Relationship
Friend
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.
So far both agencies that I have been work is good to me. But I need to look for another coz the salary that I had been receiving is not sufficient to our needs.
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)
No Resume Uploaded
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
Gloria S. Talapian

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
January 6, 2020
This application has been submitted and can no longer be edited.