Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Chardohnnay Lajoy Singh
Created: 01/22/2020
Other names under which employment may be verified:  
Updated: January 23, 2020

Home Address
Street Address
8821 s loomis st
Unit/Suite Number
City ST/Zip
Chicago, IL 60620
Home Phone
Mobile Phone
331-643-3147
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? My own research
Rate of pay desired.   13.00
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
No
Dogs
Yes
Smoker
No
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Addus homecare

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’ll bring team work and leadership, also knowledge of taking care of people that’s elderly or disabled, my communication skills

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

I took a CNA class in high school, I passed all my clinical and class work. I also have a father whose been paralyzed from the waist down since 2012 and because my father was staying in a different city then I was my mother felt terrible and sent me to stay with my father.. when I was living with him I was assisting him in his activities of daily living and his bathing and clothing & dietary needs and just getting him out the house for fresh air and exercise

Availability

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

Education

High School   Living free center
Location:   Chicago Illinois
Did you graduate?   Yes
Subjects Studied   High school diploma

College   
Location:   
Did you graduate?   
Degree:   

Other:   
Location:   
Did you graduate?   
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
Ups CACH
Phone
N/A
Address

1 UPS WAY
Hodgkins, IL

Supervisor
Angie
Job Title
Package handler
Salary or Rate of Pay
13.00
Responsibilities
Load/unload trailer trucks & sort small packages
From
05/15/2019
To
08/31/2020
Reason for Leaving
Almost hurt my back
May we contact this employer?  Yes

Company Name
Speedway cafe
Phone
+1 (800) 643-1948
Address

1495 E Wilson St
Batavia, IL 60510
United States

Supervisor
Spencer
Job Title
Cafe crew
Salary or Rate of Pay
13.00
Responsibilities
Prepare customer meals, wash dishes, make doubts/pastries
From
08/21/2018
To
11/18/2018
Reason for Leaving
Moved back to Chicago
May we contact this employer?  Yes

Company Name
Hudson Group
Phone
N/A
Address

Ohare Airport

Supervisor
Ishmael
Job Title
Sales associate
Salary or Rate of Pay
13.00
Responsibilities
Cashier,upselling,restocking
From
01/13/2019
To
04/26/2019
Reason for Leaving
Quit
May we contact this employer?  Yes

Company Name
Steak ‘n Shake
Phone
618-244-9466
Address

130 N 44th st
Mount Vernon, IL 62864

Supervisor
Cheyanne
Job Title
Server
Salary or Rate of Pay
5.00
Responsibilities
Service customers food, clean tables/Dinning area,remake/Restock items
From
02/05/2018
To
05/17/2018
Reason for Leaving
Moved to Chicago
May we contact this employer?  Yes

Company Name
McDonald’s
Phone
618-242-7802
Address

2806 Broadway St
Mount Vernon, IL 62864
United States

Supervisor
James
Job Title
Crew
Salary or Rate of Pay
8.25
Responsibilities
Cashier, cook, customer service
From
08/17/2016
To
01/02/2018
Reason for Leaving
Quit
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 was just seeking jobs and I’ve been applying myself since my last job
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
Jerome weatherspoon
Phone
773-708-8751
Address
N/a
Relationship
Friend

Name
Phone
Address
Relationship

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 was just seeking jobs and I’ve been applying myself since my last job
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
Chardohnnay singh

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
January 23, 2020
This application has been submitted and can no longer be edited.