Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Louise juanita Jones
Created: 01/28/2020
Other names under which employment may be verified:  
Updated: February 22, 2020

Home Address
Street Address
7255 s. euclid
Unit/Suite Number
City ST/Zip
chicago, IL 60649
Home Phone
7084904919
Mobile Phone
7084904919
Alternate Phone
7084904919

Have you ever worked for us before?   No
If no, how did you hear about us? online searching
Rate of pay desired.   $12
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
Yes
Hospice
Yes
Cats
No
Dogs
No
Smoker
Yes
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  home instead

How many years have you worked as a professional caregiver?  20
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.

by been the best caregiver I know I can be all my clients loved me

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

I took care both of my grandmothers before passing I also been a professional caregiver for over 20 years I have a passion for helping I enjoying it

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   harper high
Location:   chicago
Did you graduate?   No
Subjects Studied   

College   liberty Universitys
Location:   Lynchburg
Did you graduate?   
Degree:   not yet in school online

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
home instead
Phone
7737844024
Address

4736 N. marine

Supervisor
Dion
Job Title
caregiver
Salary or Rate of Pay
$13
Responsibilities
taking care elderly people taking to doctor appoinments ,grocery shopping etc.
From
03/19/2018
To
06/18/2019
Reason for Leaving
hurt myself and had to take off doctor orders
May we contact this employer?  Yes

Company Name
Right @home
Phone
8476757945
Address

8424 Skokie Blvd

Supervisor
melissa
Job Title
caregiver
Salary or Rate of Pay
$12
Responsibilities
taking care elderly people taking to doctor appoinments ,grocery shopping etc.
From
01/10/2018
To
06/19/2019
Reason for Leaving
hurt myself and had to take off doctor orders
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 have been working but like i said i hurt myself and had to takes some months off under doctors orders
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
teyona coffee
Phone
7735123669
Address
6828 s. perry
Relationship
co-worker /friend

Name
hafanna
Phone
77323693090
Address
60 w 75th
Relationship
co-worker /sister

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 have been working but like i said i hurt myself and had to takes some months off under doctors orders
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)
If hired, would you be able to provide a copy of your Social Security Card?* (IDPH requirement)
No

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
Louise juanita Jones

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
February 22, 2020
This application has been submitted and can no longer be edited.