Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
avelina alfante
Created: 04/16/2020
Other names under which employment may be verified:  
Updated: May 19, 2020

Home Address
Street Address
4832 N spaulding ave apt BSMT
Unit/Suite Number
2
City ST/Zip
Chicago, IL 60625
Home Phone
Mobile Phone
4178273589
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us? Friend Carmencita "Bhing" de Ocampo
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
Yes
Hospice
Yes
Cats
No
Dogs
Yes
Smoker
No
What languages do you speak?   english, tagalog
Do you have any caregiver training from other home services agencies?  
If yes, explain.  nursing home dublin ireland

How many years have you worked as a professional caregiver?  20
What percent of your previous case work has been for an agency?  60
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I am a nurse by profession, i am committed and dedicated to my work.I worked for 23 years as a nurse. I wanted to work as caregiver

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

While working as a NURSE in the hospital, I worked in the nursing home also, dealing with old age people. I worked in the nursing home in all around job, including a caregiver job. I had BLS certificate

Availability

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

Education

High School   notre dame of massim
Location:   philippines
Did you graduate?   Yes
Subjects Studied   secondary

College   san pedro college
Location:   davao city philippines
Did you graduate?   Yes
Degree:   BSN

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
cork university hospital wilton cork Ireland
Phone
353214920500
Address

wilton cork

Supervisor
maura odonoghue
Job Title
nurse manager
Salary or Rate of Pay
26/hr
Responsibilities
established effective caring relationships with patients, families and other health care members
From
06/18/2017
To
10/15/2018
Reason for Leaving
taking care of my MOM
May we contact this employer?  Yes

Company Name
coxhealth south
Phone
4172247359
Address

3801 s national ave
springfield
missouri

Supervisor
kelsey burns
Job Title
nurse manager
Salary or Rate of Pay
Responsibilities
keeping safe environment for my patient. collaborates with other healthcare providers
From
11/26/2018
To
07/15/2019
Reason for Leaving
Family problem in the philippines
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
kelsey burns
Phone
4172247359
Address
coxhealth springfield MO
Relationship
nurse manager

Name
Carmencita de ocampo
Phone
8476308162
Address
4832 N spaulding ave apt BSMT
Relationship
friend

Name
maura odonoghue
Phone
353861010957
Address
cork ireland
Relationship
nurse manager
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)
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
avelina alfante

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
April 22, 2020
This application has been submitted and can no longer be edited.