Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Asia Marie Clark
Created: 11/16/2020
Other names under which employment may be verified:  
Updated: November 16, 2020

Home Address
Street Address
1850 Canal Street
Unit/Suite Number
Apt 3A
City ST/Zip
Blue Island , IL 60406
Home Phone
312-823-5513
Mobile Phone
312-823-5513
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Current employee Doreen Anderson
Rate of pay desired.   Negotiable
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?   english
Do you have any caregiver training from other home services agencies?  No
If yes, explain.  

How many years have you worked as a professional caregiver?  0
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 will be able to bring my bubbly and charismatic personality, hard work ethic, and incredibly sense of responsibility to strengthen the team at Water Tower Nursing team. I believe my work skills speak for themselves and having integrity will take you a long way.

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

Availability

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

Education

High School   Chicago High School for Agricultural Sciences
Location:   Chicago, IL
Did you graduate?   Yes
Subjects Studied   Agr.Business

College   Columbia College
Location:   Chicago, IL
Did you graduate?   No
Degree:   

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
Licensed Pharmacy Tech & Certified Pharmacy Tech

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
VH1’s Black Ink Crew Chicago/ 9 Mag Tattoo/ Ryan A. Henry (Personal Brand)
Phone
Address

2150 South Canalport Ave
Chicago, IL,60608

Supervisor
Sparkles Gantt
Job Title
Public Relations & Operations Manager
Salary or Rate of Pay
$700 a week
Responsibilities
Coordinating all public relations activities. Developing a marketing communications plan including strategy, goals, budget and tactics. Developing a media relations strategy, seeking high-level placements in print, broadcast and online media. Provide inspired leadership for the organization. Make important policy, planning, and strategy decisions. Develop, implement and review operational policies and procedures. Assist HR with recruiting when necessary. Help promote a company culture that encourages top performance and high morale. Oversee budgeting, reporting, planning, and auditing. Ensure all legal and regulatory documents are filed and monitor compliance with laws and regulations. Work with the board of directors to determine values and mission, and plan for short and long-term goals. Identify and address problems and opportunities for the company. Build alliances and partnerships with other organizations. Support worker communication with the management team.
From
11/01/2018
To
06/01/2020
Reason for Leaving
Creative differences
May we contact this employer?  Yes

Company Name
ORS HAIR CARE INC
Phone
Address
Supervisor
Antina Redmond
Job Title
Influencer Coordinator & Marketer
Salary or Rate of Pay
$2000 a month
Responsibilities
Develop and execute influencer marketing strategies and creative campaigns. Identify and build relationships with prominent influencers and creative leaders. Attend relevant events for networking and business purposes. Develop content ideas, write, and curate content. Research relevant industry experts, competitors, target audiences, and users. Brainstorm new, creative approaches to influencer campaigns. Keep abreast of emerging trends, technologies and influencers. Liaising with the marketing team to create and coordinate marketing strategies that work across different channels.
From
08/01/2020
To
Reason for Leaving
Still employed
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
Shari Clark
Phone
312-859-8254
Address
2901 South King Drive, Chicago, IL
Relationship
Sister

Name
Helena Fields
Phone
708-351-0003
Address
Relationship
Pharmacy Co-Worker

Name
Rose Kruel
Phone
312-402-3672
Address
Relationship
Long term associate
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

Even though I have been out of the health care industry for quite sometime; I am confident that I can excel in this job.

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)
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
Asia M. Clark

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
November 16, 2020
This application has been submitted and can no longer be edited.