Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Marilyn Flores Cruz
Created: 05/27/2020
Other names under which employment may be verified:  
Updated: June 16, 2020

Home Address
Street Address
4924 N Western Ave
Unit/Suite Number
City ST/Zip
Chicago, IL 60625
Home Phone
773 953 6154
Mobile Phone
773 953 6154
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Friend’s referral - Estan Panopio
Rate of pay desired.   Depends upon the case of the client and the hours that I will work.
Do you have a valid driver’s license?   No
Do you have access to a car? Yes

I am able to work client who has or lives with:
Family
No
Hospice
Yes
Cats
Yes
Dogs
Yes
Smoker
No
What languages do you speak?   english, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Help at Home

How many years have you worked as a professional caregiver?  3
What percent of your previous case work has been for an agency?  90
Please explain how you will contribute to strengthen the Water Tower Nursing team.

Having good interpersonal skills is what I can contribute to strengthen the company’s team as well as my dedication. I have patience and compassion especially to clients making them feel cared and well-attended to while making them feel that they have a family like friend in me. My main priority is to make clients’ daily living more comfortable.

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

As a caregiver, I provide care to different types of clients and client personalities. I always ensure that they are comfortable and help them with tasks that they need help with. I prepare food following their proper diet, give medications timely, help with toileting and bathing, perform light housekeeping, charting the client’s blood pressure and other information needed to be recorded, and other tasks that make client’s life easier.

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   Manuel L. Quezon High School
Location:   Manila,Philippines
Did you graduate?   Yes
Subjects Studied   

College   Quezon City Medical Center
Location:   Quezon City, Philippines
Did you graduate?   Yes
Degree:   BS 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
Illinois Home Care Specialists Inc.
Phone
224 676 0139
Address

8031 N Milwaukee Ave, Niles, IL, 60714

Supervisor
Cora Kroku
Job Title
Caregiver
Salary or Rate of Pay
$150 per day live in
Responsibilities
Accompanied and transported client to dialysis appointments, provided care to clients, assisted in daily tasks such as toileting, dressing up, grooming, prepared meals following client’s diet, logged and recorded necessary data such as blood pressure and blood glucose count, prepared and accurately gave medicines to clients, and other tasks that will make the patient’s daily living easier and comfortable
From
01/08/2018
To
10/10/2019
Reason for Leaving
Lack of work-deceased patient
May we contact this employer?  Yes

Company Name
Comfort Homes
Phone
312 929 7370
Address

3501 Algonquin Rd., Ste 560, Rolling Meadows, IL, 60008

Supervisor
Divine
Job Title
Caregiver
Salary or Rate of Pay
$150 per day live in
Responsibilities
Provides care to clients, assists in daily tasks such as toileting, dressing up, grooming, prepares meals following client’s diet, logged and recorded necessary data such as blood pressure and blood glucose count, prepares and accurately gives medicines to clients, and other tasks that will make the patient’s daily living easier and comfortable, performs housekeeping
From
09/21/2018
To
04/09/2020
Reason for Leaving
Lack of work/deceased patient
May we contact this employer?  Yes

Company Name
Companions for Seniors
Phone
866 910 9020
Address

6160 N Cicero Ave, Chicago Illinois, 60646

Supervisor
Sam Tatel
Job Title
Caregiver
Salary or Rate of Pay
$15-$17
Responsibilities
Provides care to clients, assists in daily tasks such as toileting, dressing up, grooming, prepares meals following client’s diet, logged and recorded necessary data such as blood pressure and blood glucose count, prepares and accurately gives medicines to clients, and other tasks that will make the patient’s daily living easier and comfortable, performs housekeeping
From
03/15/2018
To
05/27/2020
Reason for Leaving
Lack of work
May we contact this employer?  No

 

REFERENCES & ACCEPTANCE

Thank you for entering your employment history in Part Two. Before proceeding, could you please explain any gaps in your work history.
My employment gaps were due to lack of work-deceased patient.
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
Estan Panopio
Phone
773 396 7153
Address
Chicago, IL
Relationship
Former co worker/friend

Name
Gloria Jacinto
Phone
847 903 5310
Address
Chicago, IL
Relationship
Landlady

Name
Angela Choresca
Phone
872 235 4014
Address
Chicago, IL
Relationship
Former co-worker
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

Referral from Estan Panopio

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
My employment gaps were due to lack of work-deceased patient.
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
MARILYN FLORES CRUZ

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
May 28, 2020
This application has been submitted and can no longer be edited.