Name (First, Middle, Last)
Other names under which employment may be verified: Cynthia Perez
Updated: January 19, 2020
6431 S Keeler Ave
Chicago, IL 60629
Have you ever worked for us before? No
If no, how did you hear about us?
Rate of pay desired. Open
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:
What languages do you speak? english, spanish
Do you have any caregiver training from other home services agencies? No
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.
I have 12 years of customer service experience, 5 years of which I was managing. I am a fast learner with a very strong work ethic.
Please share one or more personal or professional experiences you have had as a caregiver.
I volunteered at a home for Alzheimer’s patients and I loved it. I was able to listen to them, assist them and keep them company. I’ve been in the service industry, but I’m eager to step in to the health care field.
Can you travel outside the city of Chicago to work? Yes
High School Lane Tech
Did you graduate? Yes
College Wright College
Did you graduate? No
Did you graduate?
Special awards you earned or courses you have taken.
U.S. Military or Naval Service No
Military branch and rank at discharge:
Licenses and Certifications
Cozy Corner Restaurant
+1 (224) 805-0772
Salary or Rate of Pay
Reason for Leaving
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.
No gaps or no explanation provided.
Please provide the names and contact information for three persons, not related to you, whom you have known for at least one year.
1 (224) 316-0422
+1 (773) 419-1105
+1 (224) 281-9646
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.
No gaps or no explanation provided.
No additional certifications or licenses provided.
Have any of your certifications or licenses been suspended or revoked?
If hired, would you be able to provide a copy of your Social Security Card?* (IDPH requirement)
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.
PART FIVE – APPLICATION SUBMISSION
January 19, 2020
This application has been submitted and can no longer be edited.