Caregiver Job Application


Application Status
Name (First, Middle, Last)
Lanie Mae Pedrigosa Becher
Created: 08/12/2019
Other names under which employment may be verified:  Lanie Mae Sunpongco
Updated: August 12, 2019

Home Address
Street Address
4418 N. St Louis Ave. Apt.3A
Unit/Suite Number
City ST/Zip
Chicago, IL 60625
Home Phone
Mobile Phone
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $20 and above
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:
What languages do you speak?   english, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Senior Home Care Provider

How many years have you worked as a professional caregiver?  6
What percent of your previous case work has been for an agency?  70
Please explain how you will contribute to strengthen the Water Tower Nursing team.

By giving a reliable, trustworthy, compassionate and caring service to clients.
Being the best caregiver that I can be is an asset and pride to the company.

Establishing good relationship with families of clients is an advantage to the company too.

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

I took care of a bed ridden 92 y. old woman named Trudy. She was in hospice when I started taking care of her. I did prepare her food and feed her.I would change her clothes and her beddings when soiled.I changed her diapers and repositioned her from time to time to avoid bed sores. We watched her favorited TV shows. Even if her verbal ability has been crippled with her condition , I still talked to her and she would respond by nodding her head or trying to say something.

She passed away while sleeping and under the care of the other weekday caregiver.

Her daughter still kept in touch with me even if her mom already passed away. We see each other during summer time as she would invite me to her pool for swimming together with my family.

Now I took care of an 94y.o man,Mr. Balzekas. He was still able but was fall risk. I prepared his meals, assisted him in the bathroom, gave his pills and would do light housekeeping too.


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


High School   Mati National Comprehensive High School
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   

College   Ateneo de Davao University
Location:   Philippines
Did you graduate?   Yes

Did you graduate?   

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


Please update your application with your employment history. No employment history found.


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.


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?  
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)

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
Disclaimer has not been accepted. Job Application will not be processed until the Disclaimer is accepted.


Application Status
Date Submitted