Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Kathleen Mary McLaughlin
Created: 03/27/2020
Other names under which employment may be verified:  Kathleen Hughes
Updated: March 31, 2020

Home Address
Street Address
449 N. Clinton St.
Unit/Suite Number
City ST/Zip
Chicago, IL 60654
Home Phone
Mobile Phone
6309510050
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? online
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
Yes
Cats
Yes
Dogs
Yes
Smoker
No
What languages do you speak?   english
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?  25
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.

I am precise. I will do all my tasks. diligently. I have knowledge of medication side effects.

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

I am very compassionate,I got close to most of my clients.

Availability

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

Education

High School   HolyFamilyAcademy
Location:   Chicago,IL
Did you graduate?   Yes
Subjects Studied   College Prepatory

College   University of Illinois,College of Nursing
Location:   Chicago
Did you graduate?   Yes
Degree:   BS Nursing

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
A $ 2000.00 Grant was given to me at my first Nursing position.

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Maxim Nursing Agency
Phone
312 577 7522
Address

150 N. Wacker Dr.
Chicago,IL 60606

Supervisor
Kevin Swisher
Job Title
Recruiter
Salary or Rate of Pay
$20.00/per hour Flu Clinic $30.00/hour LongTerm Care
Responsibilities
Running Flu Shot Clinic, Giving Vaccines. Passing Meds,Change Dressings, Diabetic Care, GI Tube Feeding, Giving Breathing Treatments, Giving Comfort CareHospice C
From
06/15/2010
To
11/15/2019
Reason for Leaving
Company no longer giving Flu Shots
May we contact this employer?  Yes

Company Name
Phone
Address
Supervisor
Job Title
Salary or Rate of Pay
Responsibilities
From
To
Reason for Leaving
May we contact this employer?  Yes

Company Name
Phone
Address
Supervisor
Job Title
Salary or Rate of Pay
Responsibilities
From
To
Reason for Leaving
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
Mary Livorsi
Phone
630 369 9783
Address
1734 Windward Ave.
Relationship
Friend

Name
Mrs. Kim Wilson
Phone
312 972 9902
Address
720 d Simonton St.
Relationship
Friend

Name
Phone
Address
449 N. Clinton St.
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?  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)
No

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
Kathleen Mary McLaughlin

PART FIVE – APPLICATION SUBMISSION

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