Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Starsha Mitchell
Created: 09/07/2020
Other names under which employment may be verified:  
Updated: October 19, 2020

Home Address
Street Address
7754 s ada
Unit/Suite Number
City ST/Zip
Chicago, IL 60620
Home Phone
13124202736
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   15.75
Do you have a valid driver’s license?   No
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?  No
If yes, explain.  

How many years have you worked as a professional caregiver?  6
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.

I am a great worker an also I am team player.. I pick up the slack for my team that way we all are on the same page.

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

I have been an nursing assistant for 6years.. I have been in many different situations in my yrs. I dont like to see any of my residents/patients hurting... I ve played the role as their caregiver their listening ear an friend when in need of one i take my job very serious

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   Chicago vocational high school
Location:   Chicago il
Did you graduate?   No
Subjects Studied   

College   Dawson tech
Location:   Chicago il
Did you graduate?   Yes
Degree:   Ged

Other:   Dawson tech
Location:   Chicago il
Did you graduate?    Yes
Degree:   Nursing assistant

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
Bria of forest edge
Phone
7734366600
Address

8001 s western

Supervisor
Dominique johnson
Job Title
Cna
Salary or Rate of Pay
15.75
Responsibilities
Feeding dressing and bathing residents...helping with everyday living
From
02/28/2020
To
Reason for Leaving
Maternity leave
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
Anthony breckenrideg
Phone
7086466400
Address
2435 E Priscilla Ln
Relationship
Ex cowroker

Name
Derrick patrick
Phone
7734122007
Address
1734 e 72nd street
Relationship
Ex coworker

Name
Shanique robinson
Phone
3127781882
Address
Relationship
Ex coworker
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
Starsha mitchell

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
September 7, 2020
This application has been submitted and can no longer be edited.