Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Elizabeth S Mercado
Created: 05/11/2020
Other names under which employment may be verified:  
Updated: May 26, 2020

Home Address
Street Address
4541 N Sheridan Rd
Unit/Suite Number
Apt 401
City ST/Zip
, IL 60640
Home Phone
Mobile Phone
312-684-0750
Alternate Phone
847-987-9254

Have you ever worked for us before?   No
If no, how did you hear about us? Thru internet
Rate of pay desired.  
Do you have a valid driver’s license?   Yes
Do you have access to a car? No

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?  Yes
If yes, explain.  Freedom Homecare

How many years have you worked as a professional caregiver?  16
What percent of your previous case work has been for an agency?  100
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I'm offering my dedication, empathy, and compassion that I have been practicing to all of my clients. I work hard and take this vocation seriously knowing that this is my bread and butter. I easily cope and work well with others. I could also contribute my 16-year experience as a CNA to your clientele. I'm never stagnant and is willing to learn and continuously grow to better serve my clients.

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

One of the cases I'll never forget was with a hospice client in a facility. I was told by the nurse to cleans get and make her ready for the day. I observed that her hair was so dirty and unmanaged so I asked the nurse if I could cut them after her hairwash. The nurse said ok if I can do it. I managed convince her and she was appreciative. Before I left that very first day of my duty, she passed.

Availability

Days   Yes
Nights   Yes
Weekdays   Yes
Weekends   Yes
Live-in   Yes
Can you travel outside the city of Chicago to work?   Yes

Education

High School   Paracale High School
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   All

College   Tanauan Institute
Location:   Batangas, Philippines
Did you graduate?   Yes
Degree:   M.A. In Education

Other:   CNA
Location:   Chicago
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
Private client Elizabeth Mitchell
Phone
847-602-6053
Address

1738 Chicago Ave Apt 601
Evanston IL 60201

Supervisor
Job Title
Salary or Rate of Pay
Responsibilities
Client's ADL's
From
02/06/2017
To
06/25/2018
Reason for Leaving
Disagreement with the agency's manager (Visiting Angels of Evanston)
May we contact this employer?  Yes

Company Name
Freedom homecare Private Client Cissy Shapiro (deceased) Scott Shapiro (son)
Phone
312-961-4101
Address

2200 Golf Rd
Glenview IL 60025

Supervisor
Patti Cannella
Job Title
Salary or Rate of Pay
Responsibilities
Client’s ADL’s
From
11/19/2018
To
10/14/2019
Reason for Leaving
Client was put under the care of the facility to evoking on the expenses.
May we contact this employer?  Yes

Company Name
Freedom Homecare Private client Arlene Don
Phone
847-835-3456
Address

1 Glade Rd
Glencoe IL 60022

Supervisor
Patti Cannella
Job Title
CNA
Salary or Rate of Pay
$165 + $15 food Allowance
Responsibilities
Client's ADL'S
From
11/04/2019
To
05/08/2020
Reason for Leaving
I didn't want to cause further conflict with the client that I nor my agency could resolve, so I quit
May we contact this employer?  Yes

Company Name
Freedom Homecare
Phone
847-433-5788
Address

1749 Greenbay Rd
Highland Park IL60035

Supervisor
Patti Cannella
Job Title
CNA
Salary or Rate of Pay
$165 + $15 food Allowance
Responsibilities
ADL's of clients
From
To
05/08/2020
Reason for Leaving
Still connected, I just lost my client. I just need job now and they don't have Live-in jobs right now
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
Scott Shapiro
Phone
312-961-4101
Address
Chicago, IL
Relationship
Son of previous client

Name
Allyn Edmonds
Phone
215-806-2313
Address
Pennsylvania
Relationship
Daughter of a former client

Name
Louise Sprengelmeyer
Phone
224-435-7267
Address
Morton Grove, IL
Relationship
POA of previous client
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I'm willing to undergo training and could start anytime.

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
Elizabeth Mercado

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
May 12, 2020
This application has been submitted and can no longer be edited.