Caregiver Job Application


APPLICANT INFORMATION

Application Status
Draft
Name (First, Middle, Last)
Ninotchka Cabrera
Created: 01/27/2020
Other names under which employment may be verified:  
Updated: January 29, 2020

Home Address
Street Address
55 S.Shaddle Avenue
Unit/Suite Number
Apartment 208
City ST/Zip
Mundelein, IL 60060
Home Phone
Mobile Phone
224-292-8081
Alternate Phone
224-292-8082

Have you ever worked for us before?   No
If no, how did you hear about us? Online
Rate of pay desired.   $200
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?  No
If yes, explain.  

How many years have you worked as a professional caregiver?  10
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.

With my Degree in Nursing (BSN) and my 10-year experience as a caregiver, I have the confidence to work in this prestigious company and learn more skills as we work as team. In addition to my educational background, I am also willing to undergo training/s in order to enhance my knowledge and skills in providing the best service possible to the clients and their families that I will be assigned to.

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

I only had 1 client for 10 years and she was diagnosed of Multiple Sclerosis (MS). Sad to say that she passed away in December 2019. I am so confident to say that I did a good job on her from the first day I started until her last breath. Even her daughter can tell how I took care of her Mom in her behalf.

Availability

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

Education

High School   1985
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   

College   1993
Location:   Philippines
Did you graduate?   Yes
Degree:   Bachelor of Science in Business Administration

Other:   Nursing
Location:   Philippines
Did you graduate?    Yes
Degree:   Bachelor of Science in Nursing

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
Independent/Private Nurse
Phone
224-292-8081
Address

55 S.Shaddle Avenue
Apartment 208
Mundelein, Illinois

Supervisor
Faith Suan, Client’s Daughter
Job Title
Independent/Private
Salary or Rate of Pay
$200
Responsibilities
Activities of Daily Living, Meal Preparation, Medication Reminders, keeping the client busy through Memory Games such as puzzles, dominoes, card games, watching her favorite TV shows, etc light housekeeping, doing errands with her like grocery shopping, doctors appointment, church, family functions
From
To
Reason for Leaving
My Client passed away in December 2019
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 on vacation for 2 weeks
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
Roel Ong
Phone
224-622-6057
Address
Lake in the Hills, Illinois
Relationship
Friend

Name
Jane Ramos
Phone
847-219-0518
Address
Lake Villa, Illinois
Relationship
Friend

Name
Myrna Thayer
Phone
773-510-0516
Address
Elko, Nevada
Relationship
Friend
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 on vacation for 2 weeks
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
Ninotchka Cabrera

PART FIVE – APPLICATION SUBMISSION

Application Status
Draft
Date Submitted