Caregiver Job Application


Application Status
Name (First, Middle, Last)
Racquelle Leschet Montgomery
Created: 06/18/2019
Other names under which employment may be verified:  
Updated: June 18, 2019

Home Address
Street Address
10023 s Van Vlissingen rd
Unit/Suite Number
City ST/Zip
Chicago , IL 60617
Home Phone
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Online Job Searching
Rate of pay desired.   12.00
Do you have a valid driver’s license?   No
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
Do you have any caregiver training from other home services agencies?  
If yes, explain.  

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 will make all of clients happy and I am a loving and caring person I enjoy helping anyone especially my elders. I will do whatever I have to just to make the client happy.

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

I have no professional experiences but I have helped my Grandmother since I was 14 then my Auntie she had breast cancer I had to help wrap her and drain her breast I helped her to the restroom also I even cooked for her until she died in May 2017. I even helped my Godmother she was a diabetic and I helped her with her shots and I went for walks with her she loved it but unfortunately she passed last year February 2018. I've always helped out any of my family members when I could I'm a loving caring person I have a big heart and I always smile even if I am sad I still smile because I Know God has a plan for me so I keep smiling.


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


High School   Charles Houston High School
Location:   Chicago Illinois
Did you graduate?   No
Subjects Studied   English,Algebra,Calculus, Biology

Did you graduate?   No

Did you graduate?    No

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


Please update your application with your employment history. No employment history found.


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.
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.


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.
No gaps or no explanation provided.
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)

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
Disclaimer has not been accepted. Job Application will not be processed until the Disclaimer is accepted.


Application Status
Date Submitted
June 18, 2019
This application has been submitted and can no longer be edited.