Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Towanner Latay King
Created: 01/08/2020
Other names under which employment may be verified:  
Updated: January 24, 2020

Home Address
Street Address
715 N Hamlin
Unit/Suite Number
City ST/Zip
Chicago , IL 60624
Home Phone
Mobile Phone
7736586259
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? On google
Rate of pay desired.  
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
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Help at home and new age elder care

How many years have you worked as a professional caregiver?  2
What percent of your previous case work has been for an agency?  2
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I would be able to provide great work and respect to my clients and help them to the best of my ability.

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

I was able to do home care for a woman who couldn’t walk I made sure I gave her the best care possible and made her feel completely safe having me as a care giver for her .

Availability

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

Education

High School   Albizu Campos
Location:   Chicago Illinois
Did you graduate?   Yes
Subjects Studied   Open

College   
Location:   
Did you graduate?   No
Degree:   

Other:   
Location:   
Did you graduate?    No
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
New age elder care
Phone
8474305330
Address

2539 W Peterson

Supervisor
Sabrina
Job Title
Home care aide
Salary or Rate of Pay
13$
Responsibilities
Cook , clean
From
05/17/2017
To
09/07/2018
Reason for Leaving
I had a client close to my house he didn’t need me anymore because a family member became his care giver I wanted more than 2 months for a new client so I moved on to find work .
May we contact this employer?  Yes

Company Name
Illinois central school bus
Phone
7739387642
Address

2555 S blue island

Supervisor
Linda
Job Title
School bus aide
Salary or Rate of Pay
14$
Responsibilities
Sit on the school bus and watch the kids from morning and afternoon
From
09/08/2018
To
01/01/2020
Reason for Leaving
I’m still here at this job
May we contact this employer?  Yes

Company Name
Help at home
Phone
773-272-6100
Address

1 north state street

Supervisor
Angle Thomas
Job Title
Home care aide
Salary or Rate of Pay
11$
Responsibilities
Clean , cook if needed
From
01/07/2016
To
04/04/2017
Reason for Leaving
Found new work
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.
I love to work with people who need my help I’ve been doing it for as many job as I can get .
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
Edrena
Phone
7739387642
Address
2555 S blue island
Relationship
Coworker /manger

Name
Marie
Phone
773-817-5433
Address
925 W division
Relationship
Teacher

Name
Phone
Address
Relationship
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.
I love to work with people who need my help I’ve been doing it for as many job as I can get .
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
Towanner king

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
January 8, 2020
This application has been submitted and can no longer be edited.