Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Brenda Marie Plump
Created: 02/05/2020
Other names under which employment may be verified:  
Updated: February 5, 2020

Home Address
Street Address
36 E. 157th St
Unit/Suite Number
City ST/Zip
South Holland, IL 60473
Home Phone
N/A
Mobile Phone
708-743-7284
Alternate Phone
773-571-9974

Have you ever worked for us before?   No
If no, how did you hear about us? Church member Patsy Brown
Rate of pay desired.   $13 per hour
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
No
Smoker
No
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  State of IL, Premier Home Health Care, Home Instead Senior Care

How many years have you worked as a professional caregiver?  5
What percent of your previous case work has been for an agency?  66
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I communicate effectively with patients while also listening and meeting their needs. I am also patient, respectful and enjoy working with seniors.

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

I was a personal assistant to a disabled individual for 1 1/2 years. During that time in addition to providing ADL and companionship for him, I also assisting him in obtaining benefits available to him.

Availability

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

Education

High School   Harlan High School
Location:   Chicago, IL
Did you graduate?   No
Subjects Studied   English, Math, Social Studies, Science

College   Olive Harvey College
Location:   Chicago, IL
Did you graduate?   No
Degree:   Medical Terminology III Certificate

Other:   Chicago Professional College
Location:   Chicago, IL
Did you graduate?    Yes
Degree:   GED, Secretarial Diploma

Special awards you earned or courses you have taken.
CPR and First Aid Certified

Military Service

U.S. Military or Naval Service   No
Military branch and rank at discharge:   

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Home Instead Senior Care
Phone
815-725-2050
Address

3077 W. Jefferson St.
Joliet, IL 60435

Supervisor
Job Title
Home Care Aide
Salary or Rate of Pay
$9.75 per hour
Responsibilities
provided ADL to seniors in their home, prepared meals, accompanied them to appointments, light duty housekeeping, provided companionship
From
01/06/2014
To
02/01/2016
Reason for Leaving
Better job opportunity
May we contact this employer?  Yes

Company Name
Premier Home Health Care
Phone
708-848-0962
Address

1140 Lake St.
Oak Park, IL 60301

Supervisor
Jennifer
Job Title
Home Care Aide
Salary or Rate of Pay
$11.00 per hour
Responsibilities
provided care to seniors in their home, accompanied them to appointments, prepared meals and light duty housekeeping
From
02/01/2016
To
03/01/2018
Reason for Leaving
Better job opportunity
May we contact this employer?  Yes

Company Name
State of IL
Phone
217-782-2722
Address

325 West Adams Street
Springfield, IL 62704

Supervisor
Job Title
Personal Assistant
Salary or Rate of Pay
$13.40 per hour
Responsibilities
Assisted client with daily needs, ran errands, accompanied to appointments, prepared meals
From
03/01/2018
To
09/18/2019
Reason for Leaving
Client passed away.
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.
N/A
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
Marilyn Boston
Phone
843-492-8846
Address
739 Red Oak Ln University Park, IL 60484
Relationship
Former Employer

Name
Pamela Batteast
Phone
708-705-9002
Address
7766 Madison River Forest, IL 60305
Relationship
Former co-worker

Name
Gloria Taylor
Phone
708-870-7073
Address
Markham, IL
Relationship
Former Supervisor
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

If I am given the opportunity to work with Water Tower Nursing clients, I will provide care to the clients to best of my ability and will represent Water Tower Nursing in a positive and professional manner.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
N/A
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)
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
Brenda Marie Plump

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
February 5, 2020
This application has been submitted and can no longer be edited.