Caregiver Job Application


APPLICANT INFORMATION

Application Status
Draft
Name (First, Middle, Last)
Sallece Lauree' Williams
Created: 07/06/2020
Other names under which employment may be verified:  
Updated: July 6, 2020

Home Address
Street Address
4850 S. Lake Park Avenue
Unit/Suite Number
Unit #1812
City ST/Zip
Chicago, IL 60615
Home Phone
3128385893
Mobile Phone
3128385893
Alternate Phone
3128385893

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $15.00 an hr
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.  European Services At Home, Inc

How many years have you worked as a professional caregiver?  6
What percent of your previous case work has been for an agency?  30
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I am a capable honorable person. I care about the quality of life of others and always try to add to that quality and even enhance it when possible. I have worked with different ethnicities and provided different levels of care. I am timely, professional and invested.

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

I have cared for my grandmother who had Alzheimer's (2 years), my Aunt afflicted with the same (currently, when needed)
While working for an agency I have taken care of elderly women from hospice to dementia, as well as a couple in their 90's.
I cooked, cleaned, assisted with medicine reminders, provided company as well as accompanying to medical appointments
when necessary. When I left the agency some offered to change to a new one if I chose to continue in the profession.

Availability

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

Education

High School   Kenwood Academy
Location:   Chicago, IL
Did you graduate?   Yes
Subjects Studied   General

College   Tougaloo College
Location:   Tougaloo, MS
Did you graduate?   No
Degree:   N/A

Other:   Roosevelt University
Location:   Chicago, IL
Did you graduate?    No
Degree:   N/A

Special awards you earned or courses you have taken.
Administrative Assitant Certificates from Chicago Public Schools

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Chicago Public Schools
Phone
773-553-1000/
Address

Main: 42 W. Madison St
Chicago, IL 60602
My Location: Brown School
54 N. Hermitage Ave
Chicago, IL 60612

Supervisor
Dr. Rollie Jones (Retired)
Job Title
Admistrative Assistant VI
Salary or Rate of Pay
$56,000 a yr
Responsibilities
Office Business Manager/Payroll for 1 AIO; 2 MSD's and a staff of 12;
From
03/05/2001
To
06/08/2012
Reason for Leaving
LAid off with 3,000 other CP{S Employees
May we contact this employer?  Yes

Company Name
Coggins Cheverlet
Phone
904-574-5317
Address

10880 Phillips Hwy
Jacksonville, FL 32256

Supervisor
Rebecca
Job Title
Receptionsit
Salary or Rate of Pay
$35,00 a yr
Responsibilities
Greating customers; 12 line phone system; maintaining reception area; Other
From
04/06/2015
To
07/31/2016
Reason for Leaving
To move back to Chicago: Other reasons
May we contact this employer?  No

Company Name
European Services At Home, Inc
Phone
312.455.0100
Address

1928 W. Fulton St.
#2N
Chicago, IL 60612

Supervisor
Tameka Jones
Job Title
Home Healthcare Provider
Salary or Rate of Pay
$13 an hr
Responsibilities
Homecare: Hospice; Cooking, cleaning, laundry; Medicine Reminders
From
04/22/2019
To
07/31/2019
Reason for Leaving
Not being paid properly (not on time); Conditions patients were left in by family; Other
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.
I included my last job in FL; My most important and longest lasting job in Chicago and my Agency experince; My resume' fills in the gaps
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
Joyce Anderson
Phone
773-690-2042
Address
4850 S. Lake Park Ave.
Relationship
Friend

Name
Bobbi Polk
Phone
773-721-2016
Address
9020 S. Euclid
Relationship
Mentor

Name
Dawn Howard
Phone
214-200-5532
Address
Dallas,TX
Relationship
College Roomate/Friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I have heard such positive things about this company, it makes me feel that I will be appreciated for my services. I hope to prove myself so that I can obtain my goal of working in the office in whatever capacity I may be needed.
Thank you for your consideration.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
I included my last job in FL; My most important and longest lasting job in Chicago and my Agency experince; My resume' fills in the gaps
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
Sallece Lauree' Williams

PART FIVE – APPLICATION SUBMISSION

Application Status
Draft
Date Submitted