Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Natalie K. Archie
Created: 06/27/2020
Other names under which employment may be verified:  n/a
Updated: June 27, 2020

Home Address
Street Address
6030 N Kenmore Ave, Apt. 217
Unit/Suite Number
City ST/Zip
Chicago, IL 60660
Home Phone
13127579153
Mobile Phone
312.757.9153
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Friend of the company - Bonnie Sohn
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
Do you have any caregiver training from other home services agencies?  
If yes, explain.  n/a

How many years have you worked as a professional caregiver?  0
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.

n/a

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

Past experience includes working as a live-in caregiver for seniors with physical and mental disabilities; as a Supportive Living, Resident Assistant helping seniors with their ADL's; and then managing an 8-unit residential building that was home to independent living seniors

Availability

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

Education

High School   
Location:   
Did you graduate?   Yes
Subjects Studied   

College   UW- Green Bay
Location:   Green Bay, WI
Did you graduate?   Yes
Degree:   B.Sc. Accounting

Other:   DePaul University
Location:   Chicago, IL
Did you graduate?    Yes
Degree:   Masters - Public Service Management

Special awards you earned or courses you have taken.
n/a

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Chicago Children's Advocacy Center
Phone
312.492.3860
Address

1240 S Damen Avenue
Chicago, IL 60608

Supervisor
Char Rivette
Job Title
Grant Accountant/Revenue Specialist
Salary or Rate of Pay
Responsibilities
Accounts receivable schedule and grants management
From
01/16/2018
To
01/03/2020
Reason for Leaving
New Opportunity
May we contact this employer?  Yes

Company Name
Illinois Department of Insurance
Phone
Address

122 S Michigan Avenue
19th Floor
Chicago, IL 60603

Supervisor
Cindy Andersen
Job Title
Financial Examiner Trainee
Salary or Rate of Pay
Responsibilities
Determine compliance with Illinois law, regulations and accepted accounting practices by reviewing insurance companies financials and related records
From
01/06/2020
To
Reason for Leaving
Current
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.
See uploaded resume for full employment history details
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
Bonnie Sohn
Phone
312.576.0511
Address
Relationship
Supervisor (Former)

Name
Yolanda Crouch
Phone
773.647.6196
Address
Relationship
Co-worker (former)

Name
Utica J. Gray
Phone
773.972.6512
Address
Relationship
Supervisor (Former)
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.
See uploaded resume for full employment history details
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)
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
Natalie Archie

PART FIVE – APPLICATION SUBMISSION

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