Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Monica Grampton
Created: 08/25/2020
Other names under which employment may be verified:  
Updated: September 10, 2020

Home Address
Street Address
7732 South Evans Avenue
Unit/Suite Number
City ST/Zip
Chicago, IL 60619
Home Phone
7085596749
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $16
Do you have a valid driver’s license?   Yes
Do you have access to a car? No

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.  20

How many years have you worked as a professional caregiver?  20
What percent of your previous case work has been for an agency?  17
Please explain how you will contribute to strengthen the Water Tower Nursing team.

with super kindness, dependability, punctual, self starter, reliability, williness to try new things, and building a trusting caring family like relationship with clients and their family.

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

I care for a 87 yr old elderly man private care who suffered with early Alzheimers from 7a-7p 4- 5 days a wk for 2 yrs. I cooked 3 meals a day, I assisted with activities like puzzles, coloring, games, outing . My client loved TCM I would play memory games after the movies by asking what was the movie about and who were the actors. I cared for him up until he passed away from heart failure. I really enjoy the experience of elderly care.

Availability

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

Education

High School   Hyde park
Location:   
Did you graduate?   Yes
Subjects Studied   General Studies

College   Triton College
Location:   River Forest IL
Did you graduate?   No
Degree:   

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
Nursing Assistant and Phelmbotomy

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
St. Paul's House
Phone
773 478 2222
Address

3800 N California

Supervisor
Maria Madina
Job Title
D.O.N
Salary or Rate of Pay
$14.75 hr
Responsibilities
care & safety of 8 residents with Alzheimers and Dementia showers pass food trays feeding assist within daily memory activities make beds transfers tolieting assist with ambulation
From
07/16/2014
To
03/07/2019
Reason for Leaving
personal
May we contact this employer?  Yes

Company Name
Lakeview Nursing & Rehab
Phone
773 348 4055
Address

735 W Diversity

Supervisor
Tasha
Job Title
HR
Salary or Rate of Pay
$15.50 hr.
Responsibilities
Care and safety of 15 residents include fall prevention answers call lights toleit diaper changes feeding showers bed baths pas food trays transfers change or make beds
From
03/11/2020
To
08/27/2020
Reason for Leaving
still employed
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.
Lakeview Nursing & Rehab
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
Lashawna Skipper
Phone
773 816 1048
Address
Chicago
Relationship
Ex coworker

Name
Sabrina Roberts
Phone
773 791 0917
Address
Alsip Il
Relationship
Ex coworker

Name
Marilyn Roberts
Phone
773 966 4076
Address
Chicago IL
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.
Lakeview Nursing & Rehab
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
Monica Grampton

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
August 27, 2020
This application has been submitted and can no longer be edited.