Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Juliette Aldershof
Created: 02/01/2020
Other names under which employment may be verified:  
Updated: March 19, 2020

Home Address
Street Address
3330 West Pershing Road
Unit/Suite Number
City ST/Zip
Chicago, IL 60632
Home Phone
773-418-6638
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? indeed
Rate of pay desired.   13.50
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
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   english, spanish
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Right at Home

How many years have you worked as a professional caregiver?  2
What percent of your previous case work has been for an agency?  75
Please explain how you will contribute to strengthen the Water Tower Nursing team.

My contribution will strengthen the Water Tower Nursing team because of my strong work ethic and passion for helping others . I know I will be able to provide the best care to all of Water Tower Nursing's residents .

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

One memorable experience I had as a CNA/caregiver was when I worked for a nursing home on the south side of Chicago , I cared for a Spanish speaking resident who had no known relatives to the knowledge of the nursing home but after speaking to her she explained to me that she did have relatives but she could never get into contact with them because no one at the the facility could understand her very well . After that , it was discovered the resident had a daughter who lived in a different state . This was very memorable to me because the resident was so happy that someone could finally understand her.

Availability

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

Education

High School   Thomas Kelly High School
Location:   Chicago , Illinois
Did you graduate?   Yes
Subjects Studied   

College   Malcolm X
Location:   Chicago , Illinois
Did you graduate?   No
Degree:   Nursing

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
Aperion care international
Phone
(773)927-4200
Address

4815 S western Blvd

Supervisor
Ifeanyl Onwumah
Job Title
Certified nursing assistant
Salary or Rate of Pay
13.50
Responsibilities
activities of daily living
From
09/25/2018
To
05/12/2019
Reason for Leaving
work related accident
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 involved in a work related accident so I took some time off , I was cleared by a doctor to work again .
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
Ifeanyl Owumah
Phone
(773)927-4200
Address
4815 s Western blvd
Relationship
supervisor

Name
latisha Bluford
Phone
(773)396-3610
Address
4815 S western blvd
Relationship
on call floor manager

Name
Antonio Avila jr.
Phone
(773)499-0977
Address
5210 s wood
Relationship
co worker
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 involved in a work related accident so I took some time off , I was cleared by a doctor to work again .
Additional Certifications
No additional certifications or licenses provided.

Have any of your certifications or licenses been suspended or revoked?  
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
Juliette Aldershof

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
March 18, 2020
This application has been submitted and can no longer be edited.