Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Carletta Evadne Johnson
Created: 10/14/2020
Other names under which employment may be verified:  
Updated: October 19, 2020

Home Address
Street Address
842 East 88th Street
Unit/Suite Number
City ST/Zip
Chicago, IL 60619
Home Phone
3127143127
Mobile Phone
3127143127
Alternate Phone
7086636500

Have you ever worked for us before?   No
If no, how did you hear about us? Friend
Rate of pay desired.   $15-17.50 hourly
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
Yes
Hospice
Yes
Cats
No
Dogs
No
Smoker
No
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Life Care @ Home, Active Home health Care, and Home Instead Senior care.

How many years have you worked as a professional caregiver?  09
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.

Work well with others, and I am a team player.i listen an been attentive to their needs. I am reliable, punctual, And caring.

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

While taking care of one of my Client, I am great-full that I was there for her in her time of need. And I was able to attend her Funeral and of support to the Grieving Family.

Availability

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

Education

High School   Knockalva High
Location:   Montego Bay
Did you graduate?   Yes
Subjects Studied   Business

College   Davis Educational Institute
Location:   Montego Bay
Did you graduate?   Yes
Degree:   Certificates

Other:   Abbey Edu Institute
Location:   Chicago iL
Did you graduate?    Yes
Degree:   Certificate

Special awards you earned or courses you have taken.
Practical Nursing/Certified Nursing Assistant.

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Home Instead Senior Care
Phone
1-708-671-2648
Address

12416 South Harlem Ave.
Suite100 Polas Heights , IL 60463.

Supervisor
Carli Higlio
Job Title
Caregiver
Salary or Rate of Pay
$11:50
Responsibilities
Meals Preparation, Laundry, cleanings, Dishes and all that is needed to be done
From
08/24/2020
To
Reason for Leaving
current employed there
May we contact this employer?  Yes

Company Name
Active Home Health Care Service’s
Phone
1-708-499-2622.
Address

5009 street oak lawn Chicago iL
60643.

Supervisor
D.K
Job Title
Caregiver
Salary or Rate of Pay
$12:00
Responsibilities
Giving Hygiene Care, Meals Preparation, cleaning,Laundry, and all that was necessary for the happiness and well being of the Client
From
11/17/2017
To
07/25/2020
Reason for Leaving
Client Deceased
May we contact this employer?  Yes

Company Name
Home Instead Senior Care
Phone
773-784-4024
Address

4736 N Marine Dr, Chicago iL 60640.

Supervisor
(Was) Liddy Davis.
Job Title
Caregiver.
Salary or Rate of Pay
$13:50
Responsibilities
To give care and do all that was necessary for the wellbeing of the clients
From
05/13/2010
To
01/13/2012
Reason for Leaving
Client Deceased
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.
Roughly 6 months
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
Rev. J.B Dillon
Phone
7735519208
Address
9545 south Colfax Ave,
Relationship
Pastor

Name
Mr. & Mrs. Annette Johnson
Phone
7733291045
Address
Chicago IL 60619
Relationship
Past employer

Name
Mrs. Marcia Crotcher
Phone
3128681777
Address
8439 South Cregier 60617
Relationship
Past coworker
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

Working as a Caregiver I do take pleasure and Full responsibility in my job. I work as an Advocate for my clients listening and pay attention to their needs.
I am Dependable, Reliable, punctual. And caring.
While taking care of My client I was able to be there for them and their family even in their transition. And time of needs, even to the point of attending their funerals. I was their as a support to the grieving family.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
Roughly 6 months
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
Carletta Johnson

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
October 14, 2020
This application has been submitted and can no longer be edited.