Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Mary Jane Manansala Mallari
Created: 08/20/2020
Other names under which employment may be verified:  
Updated: August 24, 2020

Home Address
Street Address
2322 north mobile avenue
Unit/Suite Number
City ST/Zip
Chicago, IL 60639
Home Phone
Mobile Phone
7738006203
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $20
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
No
Hospice
No
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.  Custom homecare

How many years have you worked as a professional caregiver?  9
What percent of your previous case work has been for an agency?  70
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I am a very compassionate, loving and caring individual who goes above and beyond my call of duty to make others happy, to give the best care and effectively do my job. I am a team player, i am respectful, responsible, resourceful, teachable, astute observation skills, adaptable and disciplined. I am also very patient and accommodating to clients needs and families request. I am able to function effectively under stressful conditions. With the ability to follow set of rules and protocol. I am very loyal to my patients and my employers.

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

I have been a caregiver for past 9 years for multiple individuals, i worked in a home care facility in california. I’ve worked with patients with alzheimer, stroke,dementia,diabetes,colonoscopy,palliative care, post surgery recovery,hearing disorder,senior care, cancer patient, ileostomy, and hospice care

Availability

Days   Yes
Nights   Yes
Weekdays   Yes
Weekends   Yes
Live-in   Yes
Can you travel outside the city of Chicago to work?   Yes

Education

High School   Republic central colleges
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   Yes

College   Angeles university foundation
Location:   Philippines
Did you graduate?   No
Degree:   No

Other:   Mother of Perpetual Help
Location:   Philippines
Did you graduate?    No
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
Board and Care Facilities in California
Phone
Address

Paso Robles California

Supervisor
Job Title
Fulltime Caregiver
Salary or Rate of Pay
Responsibilities
Prepared meals, helped activities of daily living and range of motion Exercises, Helped with eating, transfer clients regularly, Assisted clients with walking due to poor balance, medication reminding,
From
01/09/2011
To
05/11/2012
Reason for Leaving
Moved to Chicago
May we contact this employer?  Yes

Company Name
Mr Mark Sheridan from First Choice Homecare
Phone
William Sheridan- 847-641-9043
Address

Evanston Illinois

Supervisor
William Sheridan
Job Title
Caregiver
Salary or Rate of Pay
$160day
Responsibilities
Standby assist, catheter, med reminder, taking vital sign, assist in daily activities, exercise
From
03/12/2012
To
09/28/2012
Reason for Leaving
Client deceased
May we contact this employer?  Yes

Company Name
Mrs Rose Gorecki from HMA
Phone
Ben gorecki-925-348-6665 matt gorecki-708-203-7337
Address

Prospect heights Illinois

Supervisor
Matt Gorecki
Job Title
Caregiver
Salary or Rate of Pay
$160
Responsibilities
Lifting,bed bath, cooking, housekeeping, transferring from bed to chair,med reminder,taking vital signs, exercise
From
11/07/2012
To
05/15/2013
Reason for Leaving
Pulled out by agency replaced by male caregiver
May we contact this employer?  Yes

Company Name
Home Care Angels
Phone
847-824-5221
Address

South River Rd, Des Plaines Illinois

Supervisor
Kathy Guzman
Job Title
Caregiver
Salary or Rate of Pay
$170
Responsibilities
Doing fill-in jobs/caregiving jobs
From
01/10/2014
To
03/31/2015
Reason for Leaving
On call when i’m available
May we contact this employer?  Yes

Company Name
Mrs. Mary Croke
Phone
847-302-6090
Address

Glenview illinois

Supervisor
Jim Croke
Job Title
Caregiver
Salary or Rate of Pay
$160
Responsibilities
Cooking, light housekeeping,med reminder, bathing, standby assist,taking vital signs
From
To
Reason for Leaving
Client deceased
May we contact this employer?  Yes

Company Name
Grisworld Homecare
Phone
Address

Libertyville,illinois

Supervisor
Job Title
Salary or Rate of Pay
$170 day
Responsibilities
Doing fill-in caregiving jobs
From
To
Reason for Leaving
On call when i’m available
May we contact this employer?  Yes

Company Name
Mr. Anthony Danielak
Phone
847-757-3494
Address

Lake Forest

Supervisor
Anthony Danielak Jr.
Job Title
Caregiver
Salary or Rate of Pay
$170
Responsibilities
Cooking, bathing, standby assist, bathing, mild housekeeping,med reminder, dr appointment
From
06/10/2015
To
01/29/2016
Reason for Leaving
Client deceased
May we contact this employer?  Yes

Company Name
Mr Merril Becker
Phone
708-267-2010
Address

Riverside illinois

Supervisor
Caroline joss
Job Title
Caregiver
Salary or Rate of Pay
$250
Responsibilities
Bathing, dressing, personal hygiene,prepared food, standby assist, walking, exercising, watch his favorite movies with him, med reminder, dr appointment
From
06/03/2016
To
01/27/2019
Reason for Leaving
Client deceased
May we contact this employer?  Yes

Company Name
Mrs Rose Becker
Phone
708-267-2010
Address

Riverside

Supervisor
Job Title
Caregiver
Salary or Rate of Pay
$250 livein
Responsibilities
Driving, med reminder, food preparation, standby assist
From
06/02/2016
To
12/10/2018
Reason for Leaving
Went to the philippines. Had the operation
May we contact this employer?  Yes

Company Name
Custom homecare
Phone
7735614663
Address

West peterson avenue

Supervisor
Job Title
Caregiver
Salary or Rate of Pay
15hr
Responsibilities
From
04/25/2020
To
08/11/2020
Reason for Leaving
Client was hospitalized
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.
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
Rosalita romasanta
Phone
773-490-5467
Address
Chicago illinois
Relationship
Landlord

Name
Vivian Dino
Phone
+1 (773) 968-9456
Address
Chicago
Relationship
Co- worker

Name
Caroline Joss
Phone
+1 (708) 267-2010
Address
Oak park
Relationship
Friend/advisor
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?  No
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
Mary Jane Manansala Mallari

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
August 24, 2020
This application has been submitted and can no longer be edited.