Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Ma Dames Gewargis
Created: 04/15/2020
Other names under which employment may be verified:  Maria Cabrera
Updated: April 20, 2020

Home Address
Street Address
8214 Niles Center Rd
Unit/Suite Number
Apt 1A
City ST/Zip
Skokie, IL 60077
Home Phone
Mobile Phone
847-637-7515
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Maryflor Cervantes
Rate of pay desired.   $20.00/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?  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.

I have a fantastic work ethic and care for my patients with great compassion. As a caregiver I have made a great rapport to the team of people that surrounds the patient whether it's the hospital and rehabilitation staff or the restaurant workers that my patient is a weekly patron of or the patient's family and friends that help in their all around well being. I realize it takes a team of people to succeed in making them as most comfortable as possible.

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

My recent patient/client I noticed had a limp on one foot and I insisted for him to go to the ER. I followed my instincts and called for an ambulance to take him to the hospital. It was found out then that he was having a mild stroke. I was with him for years until he passed away due to very old age.

All of my patients, I have stayed with them until the end. I do not give up on them and care for them for as long as they need me to be there. I go above and beyond what's expected of me and never ambivalent about giving them the best approach of care. I have been a caregiver for 18 years and it has provided me a lot of experiences and medical knowledge in addition to some that I've learned in nursing school.

Availability

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

Education

High School   Assumption College
Location:   Davao City, Philippines
Did you graduate?   Yes
Subjects Studied   General Studies

College   Ateneo de Davao University
Location:   Davao City, Philippines
Did you graduate?   No
Degree:   Nursing

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
Morton and Doris Oster
Phone
847-673-1668
Address

161 East Chicago Ave
Unit 32H
Chicago, IL 60611

Supervisor
Ann Heller
Job Title
Caregiver
Salary or Rate of Pay
$265/day
Responsibilities
preparing meals and medication, taking pt to md appts, overall care i.e. grooming, dressing, etc. daily routine assistance, managing house needs.
From
01/01/2010
To
11/30/2014
Reason for Leaving
pt died of old age.
May we contact this employer?  Yes

Company Name
Bernice Bobrow
Phone
847-507-9911
Address

5500 Lincoln Ave
Skokie, IL 60077

Supervisor
Iris Rosenberg
Job Title
Caregiver
Salary or Rate of Pay
$22/hour
Responsibilities
managing all around personal care of patient from preparing meals and giving medications to grooming and providing for household needs and taking pt to md appointments.
From
12/01/2014
To
05/31/2016
Reason for Leaving
patient died due to old age.
May we contact this employer?  Yes

Company Name
Nick Poulos
Phone
312-642-7526
Address

161 East Chicago Ave
Apt 55F
Chicago, IL 60611

Supervisor
Job Title
Caregiver
Salary or Rate of Pay
$25/hr
Responsibilities
preparing meals and medication, taking him to md appts, overall care i.e. grooming, dressing, etc. daily routine assistance, managing house needs.
From
07/01/2016
To
04/12/2020
Reason for Leaving
Patient/Client passed away due to old age.
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
Anne Heller
Phone
847-673-1668
Address
161 E Chicago Ave unit 32F, Chicago, IL 60611
Relationship
daughter of Client/Patient

Name
Iris Rosenberg
Phone
847-507-9911
Address
5500 Lincoln Ave, Skokie, IL 60077
Relationship
niece of Client/Patient

Name
Artemis Trebellas
Phone
217-390-8605
Address
161 E Chicago Ave unit 57F, Chicago, IL 60611
Relationship
neighbor of Client/Patient
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
Ma Dames Gewargis

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
April 15, 2020
This application has been submitted and can no longer be edited.