Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
DESIREE DANETTE HALL
Created: 01/16/2020
Other names under which employment may be verified:  NONE
Updated: January 16, 2020

Home Address
Street Address
8643 SOUTH KOMENSKY AVE
Unit/Suite Number
8643 SOUTH KOMENSKY AVE
City ST/Zip
CHICAGO, IL 60652
Home Phone
773-424-0927
Mobile Phone
708-305-2788
Alternate Phone
773-814-5800

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   indeed
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
No
Hospice
Yes
Cats
No
Dogs
No
Smoker
No
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  
If yes, explain.  NONE

How many years have you worked as a professional caregiver?  0
What percent of your previous case work has been for an agency?  0
Please explain how you will contribute to strengthen the Water Tower Nursing team.

COMPASION PERSON WATCH MY GRANDMOTHER DIE WHILE I WAS TAKING CARE OF HER, SHE MADE ME WHO I AM TODAY, I HAVE COMPASSION FOR PATIENTS AND THEIR FAMILIES MEMBER. THE MEDICAL FIELD IS A HARD WORK BUT REWARDING IF YOU ARE DEDICATED IN HELPING PEOPLE

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

DIALYSIS TECH- IT WAS THE END OF MY SHIFT WHEN I WAS WORKING AT DAVITA, ONE OF MY PAITENT WAS STILL WAITING FOR HER TRANSPORTATION TO PICK HER UP. SHE IS A DIABETIC SO WHILE WE WERE WAITING I GAVE HER MY DINNER THAT I DID NOT TOUCH THAT DAY SO THAT SHE CAN HAVE SOMETHING TO EAT/ BEEN ON MACHINE FOR 4 HOURS AND 15 MIN. TOLD HER SHE DID NOT HAVE TO PAY ME BACK IT WAS MY PLEASURE TO HELP HER. NEXT DAY HER FAMILY BROUGHT LUNCH FOR THE STAFF

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   KENNEDY-KING COLLEGE
Location:   CHICAGO
Did you graduate?   Yes
Subjects Studied   PRE NURSING

College   DAWSON TECH INST
Location:   CHICAGO
Did you graduate?   Yes
Degree:   CERTIFICATE IN CNA

Other:   PAUL ROBERSON HIGH SCHOOL
Location:   CHICAGO
Did you graduate?    Yes
Degree:   DIPLOMA

Special awards you earned or courses you have taken.
NONE

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
DAVITA MOUNT GREENWOOD
Phone
773-445-0558
Address

3401 WEST 111 STREET CHICAGO. ILLINOIS 60655

Supervisor
SONAL PATEL
Job Title
PATIENT CARE TECH
Salary or Rate of Pay
19 AN HOUR
Responsibilities
MONITOR PATIENT ON MACHINE/ CHECK WATER SYSTEMS/ ASSIST MEDICAL STAFFING WITH QUALITY PATIENT CARE
From
08/13/2004
To
06/30/2017
Reason for Leaving
TAKING CARE OF SICK MOTHER
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.
BEEN TAKING CARE OF SICK MOTHER FOR 2 YEARS
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
TAMMY POMA
Phone
773-834-4173
Address
5800 SOUTH MARYLAND
Relationship
CO-WORKER

Name
DANIELLE JONES
Phone
773-445-0558
Address
3401 WEST 111 STREET
Relationship
CO-WORKER

Name
LAVONDA MCKISSACK
Phone
312-391-3634
Address
7928 SOUTH CALIFORNIA
Relationship
FRIEND
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

HARD WORKER, COMPASSIONATE

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
BEEN TAKING CARE OF SICK MOTHER FOR 2 YEARS
Additional Certifications
No additional certifications or licenses provided.

Have any of your certifications or licenses been suspended or revoked?  
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
DESIREE DANETTE HALL

PART FIVE – APPLICATION SUBMISSION

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