Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Donna Marie Pemberton
Created: 07/04/2019
Other names under which employment may be verified:  Elphick
Updated: August 16, 2019

Home Address
Street Address
2631 Lake Avenue
Unit/Suite Number
City ST/Zip
Wilmette, IL 60091
Home Phone
847-853-7453
Mobile Phone
847-840-6992
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us? Mark Paley
Rate of pay desired.  
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?  Yes
If yes, explain.  Wesley-Passavant School of Nursing

How many years have you worked as a professional caregiver?  33
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 am an RN who is passionate about patient care to the highest degree.

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

In my second term of nursing school, I received a phone call from a patient's wife who wanted to thank me for making a difference in her's husband's emotional well being; he wrote me a letter at the end of my assignment stating he thought I would be an outstanding nurse in the future.

In my first years as an RN on the gynecology/gynecology oncology floor at Prentice Women's Hospital, I was working night shift and caring for an entire pod of patients (14 total). I had a patient who had requested a private duty nurse but none were available. By the next morning, she exclaimed to me that I had been her 'angel of mercy' throughout the night as I had been watchful/attentive to all her needs. While working day shift, an elderly patient was absolutely delighted after I had completed her bed bath and went on to soak her feet and apply lotion. She stated "Ohhh ... I can't remember the last time anyone put lotion on my feet!". And when working the evening shift, I routinely offered my patients the choice of a sleeping pill or a back rub for, hopefully, a restful night. One patient loved my back massage and had a good night's sleep before her surgery. Her surgery revealed Ovarian cancer. She was my patient during her many hospitalizations and she always requested my back massage. Her final hours of life, while no longer fully conscious, I was at her bedside massaging her neck, shoulders, arms hoping it was soothing her.

My last years in direct patient care, I worked on the Mother/Baby postpartum floor. One of the first time fathers said to me "It's really nice to have a mature nurse" as I was giving instructions/perspective on parenting. Many of my younger co-workers hurried with their care so they could go sit in the break room and read a book/text a phone message but I was fully invested in the care of my patients to the point one co-worker said to me "You do too much for your patients!". Truthfully, I took that as the ultimate compliment.

The past 12 years, due to allergies seemingly from the cleaning/disinfecting products used on hospital floors, I have worked in two non-patient care positions. In both, I have been known to hold to high standards with attention to detail while being extremely efficient. Additionally, I have strong interpersonal skills; I care and I love life.

Availability

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

Education

High School   Amos Alonzo Stagg
Location:   Palos Hills, IL
Did you graduate?   Yes
Subjects Studied   all required; National Honors Society

College   College of St. Francis
Location:   Joliet, IL
Did you graduate?   Yes
Degree:   Bachelor of Science, Health Arts

Other:   Wesley-Passavant School of Nursing, affiliated with NMH and NU
Location:   Chicago, IL
Did you graduate?    Yes
Degree:   Professional Nursing diploma

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
Northwestern Memorial Hospital
Phone
312-926-2000
Address

Huron Street and Fairbanks Ct.
Chicago, IL 60611

Supervisor
multiple
Job Title
clinical research nurse, staff nurse, External Transfer nurse coordinator, Clinical Data RN coordinator
Salary or Rate of Pay
Responsibilities
From
10/06/1986
To
Reason for Leaving
I remain at NMH, as of this date, as a full time employee
May we contact this employer?  Yes

Company Name
St. Mary's Medical Center
Phone
Address

900 E Oak Hill Avenue
Knoxville, TN 37917

Supervisor
Diane Dobbins
Job Title
staff nurse
Salary or Rate of Pay
Responsibilities
From
06/17/1985
To
12/13/1985
Reason for Leaving
out-of-state move
May we contact this employer?  Yes

Company Name
Northwestern Memorial Hospital
Phone
312-926-2000
Address

Huron Street and Fairbanks Ct.
Chicago, IL 60611

Supervisor
multiple
Job Title
staff nurse; assistant head nurse; clinical research nurse
Salary or Rate of Pay
Responsibilities
From
06/28/1976
To
12/31/1984
Reason for Leaving
out-of-state move
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.
The gap from December 1984 through June 1985 was due to a making an out of state move and having/recovering from major surgery. The gap from December 1985 until October 1996 was due to an out of state move as well as a hiring freeze at NMH so I was hired as a clinical research nurse with Northwestern University in March 1996 until the freeze ended in October 1996.
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
Dr. Robert Fragen
Phone
847-446-0184
Address
Winnetka IL
Relationship
NMH Anesthesiologist who hired me multiple times to be his research nurse

Name
Sheila Ramsey
Phone
773-802-3499
Address
Orland Park IL
Relationship
friend and former co-worker

Name
Benita Anderson
Phone
847-657-6572
Address
Glenview IL
Relationship
friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

Since I am currently employed full time, I would be looking for casual/part time at least initially, to see if it could be a good fit for future full time employment. Lastly, it seems your system isn't accepting the downloading of my resume. Maybe I can share it through email?

Thank you for your time and consideration!

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
The gap from December 1984 through June 1985 was due to a making an out of state move and having/recovering from major surgery. The gap from December 1985 until October 1996 was due to an out of state move as well as a hiring freeze at NMH so I was hired as a clinical research nurse with Northwestern University in March 1996 until the freeze ended in October 1996.
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
Donna M Pemberton

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
July 4, 2019
This application has been submitted and can no longer be edited.