Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Ilka Damasia Pimenta
Created: 10/18/2020
Other names under which employment may be verified:  
Updated: October 19, 2020

Home Address
Street Address
111 N Lamon Ave.
Unit/Suite Number
City ST/Zip
Chicago, IL 60644
Home Phone
12192819861
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Previous employee
Rate of pay desired.   16
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
No
Cats
No
Dogs
Yes
Smoker
No
What languages do you speak?   english, spanish
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Right At Home

How many years have you worked as a professional caregiver?  2
What percent of your previous case work has been for an agency?  2
Please explain how you will contribute to strengthen the Water Tower Nursing team.

My positive mental attitude, warm, and empathetic presence will make a difference between a dismal day and a bright one while working with my patients at your agency. I always try to do interesting activities with my clients like going to a library to pick up books, watch a movie or play a game. Essentially I try to accommodate all of my patients' needs in order to make companionship when they feel lonely. My communication skills and caring personality can improve their quality of life when I am working with them. I have also acquired knowledge and learned technical skills regarding how to deal with dementia, cerebral palsy, pancreatic cancer or injuries like broken ankles and knees that can help minimize their pain and improve their lives greatly. With my supervisors and colleagues I am a good listener and always arrive on time for my shifts.

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

I have worked with many clients who have had a variety of diseases but I will always remember a patient that I met and worked with in the beginning of this year. She was in a wheelchair and depended on me for all her basic needs. We built a great relationship, I recall fantastic stories about her professional life as a teacher and grandma, also about her life in Michigan. She was suffering a lot but her strength and attitude towards life will always be an example for me.

Availability

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

Education

High School   Escola Secundaria Dr. Joaquim de Carvalho
Location:   Figueira Da Foz
Did you graduate?   Yes
Subjects Studied   

College   University of Azores
Location:   Ponta Delgada
Did you graduate?   Yes
Degree:   Bachelor's in Biology

Other:   
Location:   
Did you graduate?   
Degree:   

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
Custom Home Care, LLC
Phone
773-561-4663
Address

2716 W Peterson
Chicago IL 60659

Supervisor
Jennifer Avila
Job Title
Senior Caregiver
Salary or Rate of Pay
15 per hour
Responsibilities
Provide wellness care to residents, assist them to look and feel their best everyday, through personal care.
From
03/23/2020
To
Reason for Leaving
May we contact this employer?  Yes

Company Name
Right At Home
Phone
219-756-6522
Address

500 W Lincoln Hwy Suite E-2
Merrillville
IN 46410

Supervisor
Rachel Smith
Job Title
Senior caregiver
Salary or Rate of Pay
13.50
Responsibilities
Provide all the services described in the care plan of the patient like all their special needs according to their diseases.
From
01/15/2019
To
09/27/2019
Reason for Leaving
Moved from Northwestern Indiana to Chicago
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.
I was a Middle School teacher in my country in Europe for 23 years. Moved here with my family to the U.S. I have lived in MASS for a while and two years ago I moved to IN and then to Chicago.
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
Rachel Smith
Phone
219-756-6522
Address
510 W. Lincoln Hwy Suite E-2
Relationship
Supervisor

Name
Greg Kline
Phone
765-426-8545
Address
512 Trace 5 W Lafayette IN 47906
Relationship
Friend

Name
Kelli Patrick
Phone
219-292-1521
Address
3472 Pierce St. Gary IN 46408
Relationship
Supervisor
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.
I was a Middle School teacher in my country in Europe for 23 years. Moved here with my family to the U.S. I have lived in MASS for a while and two years ago I moved to IN and then to Chicago.
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
Ilka Damasia Nunes Pimenta

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
October 19, 2020
This application has been submitted and can no longer be edited.