Caregiver Job Application


APPLICANT INFORMATION

Application Status
Draft
Name (First, Middle, Last)
Louris jade Insoy Ortiola
Created: 02/17/2020
Other names under which employment may be verified:  
Updated: October 20, 2020

Home Address
Street Address
4701 north saint louis avenue
Unit/Suite Number
City ST/Zip
Chicago, IL 60625
Home Phone
Mobile Phone
630-812-9508
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us? Website
Rate of pay desired.  
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
Yes
Dogs
Yes
Smoker
No
What languages do you speak?   english, tagalog
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?  19
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.

Value and ability to work well.

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

Empathy and compassion.

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   Saint estanislao kostka high school (4years)
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   Science, biology, chemistry, mathematics, english etc.

College   System technology institute
Location:   Philippines
Did you graduate?   Yes
Degree:   Associate in computer science

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
Larry greenstein
Phone
708-218-8545 (niece)
Address

1 east schiller street
Chicago, illinois 60610

Supervisor
Bonny (niece)
Job Title
Private caregiver
Salary or Rate of Pay
Responsibilities
Mobility assistance, shopping, assist daily exercises, doctor’s appointment, meal preparations, light housekeeping, getting his mails every morning.
From
09/18/2018
To
11/02/2018
Reason for Leaving
I went home to philippines, my husband take care of him. 2019 he died of his illness skin cancer.
May we contact this employer?  Yes

Company Name
Harriet Mc Cabe
Phone
630-355-4617
Address

1 E. bailey road
Naperville, illinois 60565

Supervisor
Mike Mc Cabe (son)
Job Title
Private caregiver
Salary or Rate of Pay
Responsibilities
Medicine reminders, accompany to church every sunday, light housekeeping, dressing, grooming, doctor’s appointment reminders, assist daily exercises, toileting, mobility assistance, personal supervision, emotional support.
From
06/16/2017
To
05/27/2018
Reason for Leaving
She moved at the brookdale assisted living home.
May we contact this employer?  Yes

Company Name
Dr. William kaufman
Phone
Address

2960 north lake shore drive apt 2900
Chicago, illinois 60657

Supervisor
Carole kaufman (wife)
Job Title
Private caregiver
Salary or Rate of Pay
Responsibilities
Showering, medicine reminders, light housekeeping, meal preparations, shopping, assist daily exercises, toileting, mobility assistance, bringing him in and out to the dining or activity.
From
07/04/2015
To
02/12/2016
Reason for Leaving
I went for a vacation to philippines.
May we contact this employer?  Yes

Company Name
Esther hirsh
Phone
847-561-5500 (son)
Address

2960 north lake shore drive apt 2607
Chicago, illinois 60657

Supervisor
Bruce hirsh (son)
Job Title
Private caregiver
Salary or Rate of Pay
Responsibilities
Personal supervision, emotional support, toileting, assist daily exercises, meal preparations, accompany going out of town, dressing, grooming, light housekeeping, medicine reminders
From
05/10/2011
To
03/18/2015
Reason for Leaving
she died at the age of 98 heart problem.
May we contact this employer?  Yes

Company Name
Dorothy de wolfe
Phone
310-351-1374
Address

2960 north lake shore drive apt 1106
Chicago, illinois 60657

Supervisor
Lucinda zimmermann (grandaughter)
Job Title
Private caregiver
Salary or Rate of Pay
Responsibilities
Medicine reminders, light housekeeping, dressing, grooming, meal preparations, doctor’s appointment reminders, assist daily exercises, toileting, shopping, mobility assistance, personal supervision, emotional support.
From
08/12/2007
To
03/27/2010
Reason for Leaving
She died of a breast cancer.
May we contact this employer?  Yes

Company Name
Flossie boles
Phone
773-383-7572
Address

2960 north lake shore drive apt 309 chicago, illinois 60657

Supervisor
Kaye wertz/dr. Bob wertz (daughter and son inlaw)
Job Title
Private caregiver
Salary or Rate of Pay
Responsibilities
Mobility assistance, emotional support, meal prepration, light housekeeping, medicine reminders, assist daily exercises.
From
05/02/2007
To
08/26/2007
Reason for Leaving
She healed from a broken ankle she no longer need assistance. Years later she died.
May we contact this employer?  Yes

Company Name
Faye stein
Phone
312- 335-1391
Address

2960 north lake shore drive apt 2000
Chicago, illinois 60657

Supervisor
Rita cohen
Job Title
Private caregiver
Salary or Rate of Pay
Responsibilities
Medicine reminders, meal preparation, light housekeeping, dressing, grooming, doctor’s appointment reminders, assist daily exercises, toileting, shopping, mobility assistance, personal supervision, emotional support.
From
04/10/2000
To
05/18/2004
Reason for Leaving
Died at 98 years old
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.
When i get sick, barely. or going for vacations.
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
Kaye wertz
Phone
773-383-7572
Address
Fullerton, chicago illinois 60614
Relationship
Friend

Name
Jessica equia
Phone
773-458-3895
Address
North ardmore avenue, chicago illinois 60659
Relationship
Friend

Name
Ivan twinamatsiko
Phone
708-340-3411
Address
Schaumburg, illinois 60173
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.
When i get sick, barely. or going for vacations.
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
Louris jade ortiola

PART FIVE – APPLICATION SUBMISSION

Application Status
Draft
Date Submitted