Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Gayle-ann Ramos
Created: 06/25/2019
Other names under which employment may be verified:  
Updated: June 28, 2019

Home Address
Street Address
7545 n winchester avenue
Unit/Suite Number
City ST/Zip
Chicago, IL 60626
Home Phone
Mobile Phone
4437352318
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Family
Rate of pay desired.   20 per hour
Do you have a valid driver’s license?   Yes
Do you have access to a car? No

I am able to work client who has or lives with:
Family
Yes
Hospice
Yes
Cats
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   english, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Sci home health

How many years have you worked as a professional caregiver?  1
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.
Please share one or more personal or professional experiences you have had as a caregiver.

I work as caregiver to a patient with special needs and attention or more care like hospice, hoyer lift, and companion as well. I took care of 6 nuns in 1 shift. I was able to give them a bath using hoyer lift, feed them on bed, etc.

Availability

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

Education

High School   Bulacan standard academy
Location:   Bulacan, philippines
Did you graduate?   No
Subjects Studied   Yes, graduate

College   Our lady of fatima univeristy
Location:   Manila, philippines
Did you graduate?   
Degree:   Yes, graduate, bachelor of science in hotel, restaurant, manager

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
Sci home health
Phone
+1 (708) 655-0125
Address

Elston ave, chicago, il, 60618

Supervisor
Ariel ruedas
Job Title
Social care worker
Salary or Rate of Pay
15 per hour
Responsibilities
Companionship and light housekeeping
From
03/06/2018
To
06/25/2019
Reason for Leaving
Looking for competitive pay.
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
Loubert diaz
Phone
(773) 717-6419
Address
7630 n olcott ave niles, il,60714
Relationship
Former Manager

Name
Dawn camil malgapo
Phone
+1 (773) 569-4515
Address
5048 north sawyer ave, chicago, il, 60625
Relationship
Family friend

Name
Cyna mae infante
Phone
+1 (773) 837-2835
Address
Zion, illinois
Relationship
Co worker
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?  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
Gayle-ann ramos

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
June 25, 2019
This application has been submitted and can no longer be edited.