Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Jesusa Trinidad Pastrana
Created: 06/08/2020
Other names under which employment may be verified:  
Updated: June 15, 2020

Home Address
Street Address
2610 W Berwyn Ave Apt 511
Unit/Suite Number
City ST/Zip
Chicago, IL 60625
Home Phone
Mobile Phone
7735583933
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.  
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, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Career Training Center

How many years have you worked as a professional caregiver?  10
What percent of your previous case work has been for an agency?  0
Please explain how you will contribute to strengthen the Water Tower Nursing team.

As a caregiver, I will do my very best to help the patients, and if I do good the good reflection goes to the agency and it will contribute to strengthen the agency.

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

I have a lot of experiences as a caregiver and all patients that I was taking care of, their family still recognized me for the kind of care that I gave to the patients.

Availability

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

Education

High School   San Ricardo Nat’l
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   

College   Araullo University
Location:   Philippines
Did you graduate?   Yes
Degree:   Bachelor of Science in Commerce

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
Claudia Piper
Phone
7342236737
Address

2117 Stephen Terrace
Ann Harbor, MI 48103

Supervisor
Job Title
Caregiver
Salary or Rate of Pay
$180/day
Responsibilities
Caregiving
From
09/02/2009
To
07/31/2017
Reason for Leaving
Patient deceased
May we contact this employer?  Yes

Company Name
Pamela Morris
Phone
7739295166
Address

5927 Woodward Ave
Downers Grove, IL 60516

Supervisor
Job Title
Salary or Rate of Pay
$18/hr
Responsibilities
Caregiving
From
12/23/2017
To
06/09/2020
Reason for Leaving
Still working w/ them
May we contact this employer?  Yes

Company Name
Dr William Mckeever
Phone
7737046763
Address

2500 Indigo Lane
Glenview, IL 60026

Supervisor
Job Title
Caregiver
Salary or Rate of Pay
$25/hr
Responsibilities
Caregiving
From
04/14/2020
To
05/31/2020
Reason for Leaving
Patient deceased
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
Claudia Piper
Phone
7342236737
Address
2117 Stephen Terrace Ann Arbor MI 48103
Relationship
Employer

Name
Pamela Morris
Phone
7739295166
Address
5927 Woodward Ave Downers Grove IL 60516
Relationship
Employer

Name
Fe Jacinto
Phone
7087176198
Address
1620 Maple Ave, Berwyn, IL 60402
Relationship
Friend
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?  
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
Jesusa Pastrana

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
June 8, 2020
This application has been submitted and can no longer be edited.