Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Margarita Pedrosa Espenilla
Created: 09/10/2020
Other names under which employment may be verified:  Maggi
Updated: October 19, 2020

Home Address
Street Address
3916 W. Washington Blvd.Apt.305
Unit/Suite Number
City ST/Zip
Chicago, IL 60624
Home Phone
N/A
Mobile Phone
7027154484
Alternate Phone
N/A

Have you ever worked for us before?   No
If no, how did you hear about us? From a friend
Rate of pay desired.   $25/hour
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
No
Dogs
No
Smoker
No
What languages do you speak?   english, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Care Academy

How many years have you worked as a professional caregiver?  12
What percent of your previous case work has been for an agency?  100
Please explain how you will contribute to strengthen the Water Tower Nursing team.

Be professional, work hard, on time and report to my supervisor immediately any work related problem specially problem with client

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

As a professional caregiver I always prioritize safety precautions, report and document , maintain a clean and healthy environment and communicate well person with Dementia. That is why all my clients I work with specially my supervisor likes me.

Availability

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

Education

High School   Graduate
Location:   Tacloban City Leyte, Philippines
Did you graduate?   Yes
Subjects Studied   English, Math, Science, History, English, Economics, Physics , Home Economics , Biology and Phusycal Education

College   Divine Word University
Location:   Tacloban, Leyte Philippines
Did you graduate?   No
Degree:   Undergraduate

Other:   Caregiving 101
Location:   Las Vegas, Nevada
Did you graduate?    Yes
Degree:   Certificate

Special awards you earned or courses you have taken.
Caregiving, Cooking, Housekeeping and Crafting

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Advocate Wellness
Phone
847.691.3810
Address

23W574 N.Ave., Carol Stream 60188

Supervisor
Johny Maco
Job Title
Caregiver
Salary or Rate of Pay
$160/day
Responsibilities
Companionship/ assist with ADL’S, prepare foods, laundry, housekeeping
From
12/25/2018
To
01/15/2019
Reason for Leaving
No health insurance
May we contact this employer?  Yes

Company Name
Platinum Care Group, Inc.
Phone
630.295.9420
Address

23 W 574 N Ave.
Carol Stream, IL 60188

Supervisor
Marquita Carlos
Job Title
Caregiver
Salary or Rate of Pay
$200/day
Responsibilities
To delineate the types of services that can be provided by a home service worker.Accept tasks and also limitations when a more medical model of assistance is needed to meet the highest needs of the client.Perform duties and responsibilities,at all times maintain work professionalism.
From
01/20/2019
To
07/23/2020
Reason for Leaving
Find a better pay and good working benefits
May we contact this employer?  Yes

Company Name
Angels HomeCare Services
Phone
312.877.0773
Address

2200 S.Main St. Suite 206 Lombard, IL 60148

Supervisor
Al Estacion
Job Title
Supervisor
Salary or Rate of Pay
$160/day
Responsibilities
Provide client assistance and general household management on a 24 hour basis depending on clients needs
From
12/25/2019
To
05/21/2020
Reason for Leaving
No permanent assignment
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.
There are times client is at the hospital so I look for an opportunity to work with my previous employer
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
Anita E. Acacio
Phone
448.667.5508
Address
4730 Silver Ranch Pl, San Jose CA 95138
Relationship
Friend

Name
Patrick Odum
Phone
773.818.0920
Address
4507 W. Wilson, Chicago IL 60630
Relationship
Bro. in Christ

Name
Joyce Hubick
Phone
312.659.5394
Address
1716 N. New England Chicago, IL 60707
Relationship
Friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

If you need to know more about me I have my current background check up, and I have been a US citizen 2014. I am from Las Vegas , I have three professional kids there, I moved here at Chicago since Oct. 2016 and I am divorced and I live alone , living in a Senior apt. and be moving soon to a better community.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
There are times client is at the hospital so I look for an opportunity to work with my previous employer
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)
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
Margarita P. Espenilla

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
September 10, 2020
This application has been submitted and can no longer be edited.