Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Ericia B’tricia Ward
Created: 05/27/2020
Other names under which employment may be verified:  N/A
Updated: June 11, 2020

Home Address
Street Address
2719 w Potomac fl 1
Unit/Suite Number
City ST/Zip
Chicago , IL 60622
Home Phone
Mobile Phone
872 333 8505
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Indeed
Rate of pay desired.   Open
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.  IDHS

How many years have you worked as a professional caregiver?  10
What percent of your previous case work has been for an agency?  6
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I can do the work and deliver exceptional results. I will fit in beautiful and be a great addition to the team.I possess a combination of skills out from the crowd . Hiring me will bring all of my skills ,Qualities,Values ,Interests,Academic knowledge and life experience to the company and willingness to learn and my desire to make my mark at the water Tower Nursing .

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

When my grandmother had an accident and fell and fractured her hip that was painful to watch her in pain. I was emotional and she has made tremendous achievement to trying to get back to walking and taking step by step. It was hard adjusting her in the normal duties at home and taking her in a wheelchair and adjusting to her situation and making changes. She is slowly recovering and I am proud of her .She is strong individual for being her age.

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   West Aurora
Location:   N/A
Did you graduate?   No
Subjects Studied   N/A

College   N/A
Location:   N/A
Did you graduate?   
Degree:   N/A

Other:   N/A
Location:   N/A
Did you graduate?   
Degree:   N/A

Special awards you earned or courses you have taken.
Healthcare Plus Senior Care

Military Service

U.S. Military or Naval Service   No
Military branch and rank at discharge:   

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Elara caring
Phone
855 727 9111
Address

11753 sw hwy ,palos Height,il

Supervisor
Andrew
Job Title
Caregiver
Salary or Rate of Pay
13.00
Responsibilities
Help with activities of daily living,bathing,dressing,meal,preparation,medication,shopping,errands etc...
From
07/12/2019
To
02/14/2020
Reason for Leaving
It was very unprofessional
May we contact this employer?  Yes

Company Name
Division of Rehabilitation
Phone
312 633 3570
Address

1151 s wood st Chicago, IL 60612

Supervisor
Hector
Job Title
Caregiver
Salary or Rate of Pay
13.00
Responsibilities
Home Management and planning,Medical Advocacy, Prescription Medication Management,Help with Personal Hygiene and care Assisting with Meals and Nutrition Help with Mobility Home Maintenance and Housekeeping Transportation and more
From
02/11/2015
To
03/12/2020
Reason for Leaving
Due to lack of hours due to covid-19
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.
Gaps -due to lack of hours due to coved-19
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
Kelly hill
Phone
773 280 0156
Address
N/A
Relationship
Manager

Name
Patricia jones
Phone
312 774 5131
Address
N/A
Relationship
Co- Worker

Name
Mlyssa
Phone
1708 369 3524
Address
Relationship
Team leader
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I am a hardworking, reliable person willing to do what it takes to get the job done.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
Gaps -due to lack of hours due to coved-19
Additional Certifications
No additional certifications or licenses provided.

Have any of your certifications or licenses been suspended or revoked?  No
If yes, explain.  Health care plus senior care
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
Ericia Ward

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
May 29, 2020
This application has been submitted and can no longer be edited.