Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Sherwin Lawrence De Leon Lovete
Created: 02/03/2020
Other names under which employment may be verified:  
Updated: February 3, 2020

Home Address
Street Address
9445 Kenton Avenue
Unit/Suite Number
Apt 304
City ST/Zip
Skokie, IL 60076
Home Phone
Mobile Phone
847-7080149
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $20/hr
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, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Best of Care

How many years have you worked as a professional caregiver?  7
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.

To be efficient and punctual caregiver

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

Experienced with ALS, Parkinson’s Disease, dementia, diabetic, hospice

Availability

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

Education

High School   Holy Cross College
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   1990

College   Wesleyan university
Location:   Philippines
Did you graduate?   Yes
Degree:   Commerce

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
Ira Godlberg
Phone
773-9689849
Address

9300 Pine Grove Avenue, Irving Park, Chicago

Supervisor
Ira
Job Title
Salary or Rate of Pay
$18/hr
Responsibilities
Companion
From
01/02/2019
To
02/01/2020
Reason for Leaving
Can be by himself
May we contact this employer?  Yes

Company Name
Harold Miller
Phone
847-3321308
Address

408 Hinman Avenue, Evanston

Supervisor
Robert Miller
Job Title
Salary or Rate of Pay
$15/hr
Responsibilities
Transferring, meal preparation, medication, showering
From
02/11/2015
To
10/18/2018
Reason for Leaving
Move to Seattle
May we contact this employer?  Yes

Company Name
Robert Gardula
Phone
847-3093815
Address

Wilmette

Supervisor
Robert Gardula
Job Title
Salary or Rate of Pay
$15/hr
Responsibilities
Medication preparation, showering, transfers, meal preparation
From
01/15/2016
To
11/25/2017
Reason for Leaving
Deceased
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.
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.
Name
Cathy Goldberg
Phone
773-9721144
Address
Relationship
Client’s wife

Name
Michelle Vincoy
Phone
505-6088081
Address
Dempster
Relationship
Ci worker

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.
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?  
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
Sherwin Lawrence Lovete

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
February 3, 2020
This application has been submitted and can no longer be edited.