Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Arkadiusz Krzysztof Sobota
Created: 10/20/2020
Other names under which employment may be verified:  
Updated: November 12, 2020

Home Address
Street Address
5801 W. Waveland Ave
Unit/Suite Number
City ST/Zip
Chicago , IL 60634
Home Phone
Mobile Phone
7735011776
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us? friend
Rate of pay desired.   13 per hour and up
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
Yes
Dogs
Yes
Smoker
No
What languages do you speak?   polish
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Online training from Relias

How many years have you worked as a professional caregiver?  4
What percent of your previous case work has been for an agency?  0
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I'm respectful person, reliable, patient and caring.

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

I used to work with combative patient. He was trying to punch me .

Availability

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

Education

High School   Grammar School in Poland
Location:   Raciborz, Poland
Did you graduate?   Yes
Subjects Studied   

College   Medical University
Location:   Bialystok , Poland
Did you graduate?   Yes
Degree:   Dentist

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
Dental Partners
Phone
+44 1202 392202
Address

Crescent Dental Practice
1-3 The Crescent
Bournemouth BH1 4EX
United Kingdom

Supervisor
Shelby Palmer
Job Title
Associate Dentist
Salary or Rate of Pay
6000 pounds per month
Responsibilities
Dental care service for patients- general dentistry, oral surgery, prosthodontics
From
06/20/2016
To
04/22/2020
Reason for Leaving
Immigration to USA after winning green card in DV lottery
May we contact this employer?  Yes

Company Name
SCA Trafalgar
Phone
+442380891936
Address

Dental Practice Holbury
Unit 9, Chevron Business Park, Lime Kiln Ln
Holbury, Hardley, Southampton SO45 2QL
United Kingdom

Supervisor
Gemma Legg- Practice Manager
Job Title
Associate Dentist
Salary or Rate of Pay
6000 pounds per month
Responsibilities
Providing general dental care for patients- general dentistry,oral surgery, prosthodontics
From
01/19/2015
To
05/06/2016
Reason for Leaving
Change the job and place to live
May we contact this employer?  Yes

Company Name
Northdown Dental Practice
Phone
+441843294750
Address

165-167 Northdown Road
Cliftonville, Margate, CT9 2PA
United Kingdom

Supervisor
Laura Scott
Job Title
Associate Dentist
Salary or Rate of Pay
7000 pounds per month
Responsibilities
Providing dental care for patients - general dentistry, oral surgery, prosthodontics
From
01/13/2013
To
03/31/2014
Reason for Leaving
Return to Poland
May we contact this employer?  Yes

Company Name
NZOZ Prodentum
Phone
+48324539050
Address

Plac Bohaterow Westerplatte 12
47-400 Raciborz
Poland

Supervisor
Ewa Kuczman-Szydlo
Job Title
Associate Dentist
Salary or Rate of Pay
1000 $ monthly
Responsibilities
Providing dental care for patients - general dentistry, oral surgery, prosthodontics
From
09/01/2003
To
09/30/2012
Reason for Leaving
Immigration to United Kingdom to work as NHS dentist
May we contact this employer?  Yes

Company Name
Emilia Wojtowicz Agency
Phone
7083883311
Address

11601 South Mayfield Ave
Alsip, Illinois 60803

Supervisor
Scott R. Peterson
Job Title
Caregiver for his father
Salary or Rate of Pay
80 $ daily
Responsibilities
Patients was after stroke , bed bounded, required transportation with hoyer lift .Patient was completely paralyzed below the neck
From
12/01/1996
To
08/28/1997
Reason for Leaving
I have to come back to Poland
May we contact this employer?  Yes

Company Name
Phone
8472558723
Address

507 S. Rammer
Arlington Heights
Illinois 60004

Supervisor
Patricia Ulrich
Job Title
Caregiver for his husband
Salary or Rate of Pay
100$
Responsibilities
Transferring with hoyer lift, sponge bath ,helping with meals - patient after 2 strokes and colon cancer
From
03/01/2003
To
06/30/2003
Reason for Leaving
death of the patient
May we contact this employer?  Yes

Company Name
Phone
312-335-1391
Address
Supervisor
Rita Cohen
Job Title
Caregiver for her son
Salary or Rate of Pay
100 $ daily
Responsibilities
Patient was after serious automobile accident . I helped him bath , dress and attend to all other things he could not do for himself
From
06/01/2001
To
09/30/2001
Reason for Leaving
patient recovered
May we contact this employer?  Yes

Company Name
Polonia Agency
Phone
7156756175
Address

10225 N.60 th. Ave
Merrill , WI 54452

Supervisor
Patricia Burgess
Job Title
Caregiver for her father who had throat cancer
Salary or Rate of Pay
100 $ daily - live in job
Responsibilities
Giving the medications, sponge bath,
From
03/03/2000
To
05/03/2000
Reason for Leaving
Death of the patient
May we contact this employer?  Yes

Company Name
Andrew Private Duty
Phone
8473097556
Address
Supervisor
Richard Roller
Job Title
Caregiver for his Brother
Salary or Rate of Pay
13 $ per hour
Responsibilities
Patient with ALS. Bed bounded. Transferring using Hoyer lift, showering, feeding tube ,
From
10/01/2001
To
12/02/2002
Reason for Leaving
I ve found another job
May we contact this employer?  Yes

Company Name
Right at Home
Phone
8473969000
Address

513 W Main St
West Dundee
IL 60118

Supervisor
Tia Podraza
Job Title
Caregiver
Salary or Rate of Pay
14 per hour
Responsibilities
transferring the patient , preparing the meals , Giving medications
From
10/08/2020
To
Reason for Leaving
I still work there but Im looking for more hours and only during the weekdays.This job is only weekends
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.
After 2003 I came back to Poland and I won a green card in Lottery in 2017
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
Adam Mider
Phone
8474145966
Address
Relationship
friend

Name
Marzena Zygmunt
Phone
7734741664
Address
Relationship
friend

Name
Gawor Sebastian
Phone
312 5139025
Address
Relationship
friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

Dear Sir or Madam

I would like to apply for the position of caregiver.

I'm 47 years old Medical School graduate from Poland. I'm empathetic and caring individual with extensive experience in caregiving field.

During my 4 years experience in caregiving I had patients after stroke, with cancer, ALS and after communication accidents. My responsibilities included light housework, giving baths, preparing small snacks, helping patients use the restroom.

I'm respectful person, reliable, patient and caring . I would be happy to attend an interview at your earliest convenience. I look forward to hearing from you .
Regards Arkadiusz Sobota

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
After 2003 I came back to Poland and I won a green card in Lottery in 2017
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
Arkadiusz Sobota

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
November 12, 2020
This application has been submitted and can no longer be edited.