Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Lena O Maples
Created: 04/27/2020
Other names under which employment may be verified:  
Updated: May 26, 2020

Home Address
Street Address
5630 South Justine street
Unit/Suite Number
City ST/Zip
Chicago , IL 60636
Home Phone
Mobile Phone
3125195457
Alternate Phone
6304888802

Have you ever worked for us before?   No
If no, how did you hear about us? Reference from contractor
Rate of pay desired.   16/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
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Open arms health care Skokie, hugehearts home health care, and current training with assisting hands , Arlington heights.

How many years have you worked as a professional caregiver?  18
What percent of your previous case work has been for an agency?  40
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I have worked with different clients in the past . I have worked with diabetes, stroke and heart patients. I have also been able to care for patients with cancer diagnoses , and were going through treatment, also in hospice. I have also had the opportunity to take care of patients with dementia . I believe that my experience would be a great asset to your organization. I started as a private caregiver in the year 2000. From then on I had several referrals due to my good work. I have had tremendous experience taking care of family members of people that I know , no negative reports from me or the clients .

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

In 2012 up to mid 2013 , I was providing care for my client who was a diabetic. Under family supervision and support, I administered daily insulin doses, planned breakfast lunch and dinner , took readings for blood sugar level and notified family in case of downset, I was able to accompany him to doctor visits- thus received instructions from his physician as well . I also helped with enforcing his physical therapy . In addition to this , I worked privately for other clients that needed help going for treatments for cancer. I helped organize transport to and from hospital , as well as making sure everything went smoothly.

Availability

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

Education

High School   Homa Bay high school
Location:   Homa Bay
Did you graduate?   Yes
Subjects Studied   English , Biology , History , CRE

College   
Location:   
Did you graduate?   
Degree:   

Other:   A level High school
Location:   Homa Bay Kenya
Did you graduate?    Yes
Degree:   NA level certification

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
Methodist home for children -private payer
Phone
9197543636
Address

1041 Washington Street
Raleigh NC

Supervisor
Bruce Stanley
Job Title
Caregiver
Salary or Rate of Pay
20$ hour as needed
Responsibilities
Took care or Dr. Gerald on behalf of Rev. Stanley and Methodist home for children
From
02/02/2015
To
07/07/2016
Reason for Leaving
Dr. Gerald relocated to a new job
May we contact this employer?  Yes

Company Name
Private duty seasonal Julie wood POA
Phone
9192701130
Address

Baird drive Raleigh NC

Supervisor
Julie wood
Job Title
Caregiver
Salary or Rate of Pay
20$ hr
Responsibilities
Personal care assistance, meds reminder , companion , meals as needed
From
02/02/2015
To
11/21/2019
Reason for Leaving
Seasonal
May we contact this employer?  Yes

Company Name
Private . David Blake POA for James Blake
Phone
Address

Euclid rd Durham NC

Supervisor
David Blake
Job Title
Caregiver
Salary or Rate of Pay
18$ hr
Responsibilities
Daytime 12 hr Monday - Saturday , meals , medication doctor appointments , vitals , physical therapy , medication administration , and insulin , personal care .
From
06/15/2012
To
04/24/2013
Reason for Leaving
Family took over care
May we contact this employer?  Yes

Company Name
Hugehearts home health care services Lagrange Illinois
Phone
7083521850
Address

639 South Lagrange Road Lagrange Illinois 60525

Supervisor
Paullette
Job Title
Caregiver
Salary or Rate of Pay
15$ per hour live in caregiver
Responsibilities
Companion , meals , baths , and personal care assistant ,
From
05/27/2016
To
12/21/2016
Reason for Leaving
Agency went out of business
May we contact this employer?  Yes

Company Name
Open arms home health care agency
Phone
8477631126
Address

4017 Oakton Street
Skokie Illinois

Supervisor
Julia
Job Title
Caregiver
Salary or Rate of Pay
13hr live in
Responsibilities
Live in caregiver
From
04/20/2016
To
11/14/2016
Reason for Leaving
Hospice assignment ended
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.
The gaps in my work history , I operated a residential cleaning business. Within the times that I had no caregiving assignment, I managed and operated a residential cleaning service, which I still do to the present day , but at a very minimal capacity due to having relocated to illinois
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
Hal K Bowman
Phone
9196068810
Address
207 Kelso ct Cary NC
Relationship
Employer

Name
Julie wood
Phone
9192701130
Address
1507 Baird drive Raleigh NC
Relationship
Manager

Name
Becky Johnston
Phone
3364086040
Address
1021 Washington Street Raleigh NC
Relationship
Employer and friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I believe that my referrals can attest to my line of work , since I have had private duty cases that they referred me to . Mr. Bowman hired me to take care of his wife , Julie wood has overseen my taking care of her mother , and her boss Mrs Julia Daniels’ s mother . Becky Johnston was my referral to Methodist home for the children. I will be happy to provide more information if needed.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
The gaps in my work history , I operated a residential cleaning business. Within the times that I had no caregiving assignment, I managed and operated a residential cleaning service, which I still do to the present day , but at a very minimal capacity due to having relocated to illinois
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
Lena O Maples

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
April 27, 2020
This application has been submitted and can no longer be edited.