Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Catalina Asuncion Ramos
Created: 02/18/2020
Other names under which employment may be verified:  
Updated: August 31, 2020

Home Address
Street Address
4441 North Hamlin Apt. 2 South
Unit/Suite Number
City ST/Zip
Chicago, IL 60625
Home Phone
Mobile Phone
773-391-5024
Alternate Phone

Have you ever worked for us before?   Yes
If yes, when? 6 years ago
Rate of pay desired.  
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
No
Cats
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   english, spanish, 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?  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.

Working with them faithfully and be more patient and give my tender loving care to all my clients.

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

When I was working with a mean client and made her nicer as I working with her.

Availability

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

Education

High School   Arellano High School
Location:   Phillippines
Did you graduate?   Yes
Subjects Studied   High School

College   Far Eastern University
Location:   Phillippines
Did you graduate?   Yes
Degree:   RN

Other:   Pharmacy Tech
Location:   Chicago, IL
Did you graduate?    Yes
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
Custom Home Care
Phone
773-561-4663
Address

2716 W. Peterson Ave.
Chicago, IL 60659

Supervisor
Shawn
Job Title
Case Manager
Salary or Rate of Pay
200
Responsibilities
taking care of patient that, feeding, grocery shopping, taking to and from doctor's appointment, laundry
From
08/15/2020
To
03/14/2020
Reason for Leaving
Client passed away
May we contact this employer?  Yes

Company Name
Sandra Miller
Phone
312-510-9526
Address

2960 N Lakeshore Dr. Chicago, IL

Supervisor
Mike Miller
Job Title
caregiver
Salary or Rate of Pay
300
Responsibilities
1. Assess medical needs of PT. 2. Assist with basic needs of PT. 3. Companionship 4. Medicine Management 5. Meal Prep and basic ADL Assistance
From
07/01/2012
To
07/01/2019
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.
stopped working as a caregiver in march of 2020 becasue of Covid-19. I baby sat my 2 grand sons from March 2020 through July 2020
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
Mike Miller
Phone
312-510-9526
Address
Previous employer
Relationship

Name
Warren Skora
Phone
312-969-8220
Address
Previous employer
Relationship

Name
Flor Tejada
Phone
510-514-7631
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.
stopped working as a caregiver in march of 2020 becasue of Covid-19. I baby sat my 2 grand sons from March 2020 through July 2020
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
Catalina Asuncion Ramos

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
August 31, 2020
This application has been submitted and can no longer be edited.