Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Helen A Wilkerson
Created: 09/15/2020
Other names under which employment may be verified:  
Updated: September 17, 2020

Home Address
Street Address
5550 N Kenmore
Unit/Suite Number
1107
City ST/Zip
chicago, IL 60640
Home Phone
Mobile Phone
773-441-0656
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Internet search
Rate of pay desired.   14.50
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?  
If yes, explain.  Right At Home

How many years have you worked as a professional caregiver?  30
What percent of your previous case work has been for an agency?  80
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I believe I would be a excellent addition to your company with my experience and my positive attitude and energy . I love working with seniors and there families ensuring that there loved ones get the best care.

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

Working with a client who was afraid to walk after experiencing a fall. I continued to encourage and support him with daily living activities which including using a gate belt and walker to improve his strength his legs and to improve balance which help him to build his confidence to walk. End result he started using his walker and leaving his wheel chair in his room.

Availability

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

Education

High School   Evanston township high school
Location:   Evanston Il
Did you graduate?   Yes
Subjects Studied   General studies

College   Robert Morris College
Location:   Chicago Il
Did you graduate?   Yes
Degree:   Associate

Other:   Oakton Commuinty College
Location:   Skokie Il
Did you graduate?    Yes
Degree:   certified 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
Private
Phone
847-769-5287
Address

3308 Noyes
Evanston IL, 60207

Supervisor
Laura Chramosta
Job Title
Home Health Cna
Salary or Rate of Pay
20.00
Responsibilities
Feeding , bathing, repositioning,range of motion, medication reminder,light housekeeping, meal preparation, companionship,support to the family.
From
06/01/2020
To
07/15/2020
Reason for Leaving
May we contact this employer?  Yes

Company Name
Admiral At The Lake
Phone
773-433-1800
Address

929 W Foster Ave
Chicago,IL 60640

Supervisor
Angela Jalloh
Job Title
Don
Salary or Rate of Pay
14.00 hrly
Responsibilities
Care Partner, medication reminder, daily activities, serving meals in dining room, light house keeping, monitor meals and intake, accompany residents to appointments,companionship.
From
04/04/2016
To
01/01/2018
Reason for Leaving
May we contact this employer?  Yes

Company Name
Edison Apartment
Phone
773-769-2973
Address

5200 N Sheridan
Chicago IL, 60640

Supervisor
Mr. Marco Johnson
Job Title
Concierge
Salary or Rate of Pay
10.00
Responsibilities
Greet residents, package intake, assist with building issue in timely manner, alert residents when visitors arrive.dents when vints with
From
01/01/2018
To
01/04/2019
Reason for Leaving
May we contact this employer?  Yes

Company Name
Right At Home
Phone
773-775-4677
Address

8424 Skokie Blvd St
Skokie, IL 6007

Supervisor
Melissa
Job Title
Supervisor
Salary or Rate of Pay
14.00
Responsibilities
In home care which includes daily living activities, meal preparation, laundry, repositioning. bed baths medication reminders, feeding, companionship.
From
04/09/2019
To
Reason for Leaving
presently working
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
Laura Chramosta
Phone
847-769-5287
Address
3308 Noyes
Relationship
previous in employer

Name
Constance Bolton
Phone
773-671-3325
Address
5042 West Division
Relationship
co-worker

Name
Greg Easter
Phone
1-832-577-1239
Address
5200 N Sheridan
Relationship
co-worker
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I have been volunteer for Chicago Food Depository for 10 years.

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
Helen Wilkerson

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
September 15, 2020
This application has been submitted and can no longer be edited.