Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Fabiola Alonso-Huerta
Created: 07/22/2019
Other names under which employment may be verified:  
Updated: July 22, 2019

Home Address
Street Address
Unit/Suite Number
City ST/Zip
Arlingtong Heights , IL 60005
Home Phone
Mobile Phone
8474312231
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   Chris Reyes
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, spanish
Do you have any caregiver training from other home services agencies?  
If yes, explain.  

How many years have you worked as a professional caregiver?  8
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.

Giving the of me as a caregiver to the people who I would be working with is very important for both party. As well for the client who deserve the best care coming from anyone who they hired to help them.

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

I’m very compassion, caring, patient person specially working with elderly people has been a job that I’ve always love to do. It gives me a great satisfaction to be able to help those who needs it.

Availability

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

Education

High School   
Location:   
Did you graduate?   Yes
Subjects Studied   

College   
Location:   
Did you graduate?   
Degree:   

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
Edith korn and Albert Korn.
Phone
(847) 830-6853
Address

Buffalo grove Illinois

Supervisor
Ismael Martínez
Job Title
Caregiver
Salary or Rate of Pay
20
Responsibilities
From
01/05/2011
To
11/20/2015
Reason for Leaving
They moved to a nursing home.
May we contact this employer?  Yes

Company Name
Harriet Koehler
Phone
+1 (914) 484-4770
Address

250 east person st 2306 Chicago

Supervisor
Lia
Job Title
Caregiver
Salary or Rate of Pay
23
Responsibilities
From
12/17/2015
To
07/10/2019
Reason for Leaving
She passed away
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
Ismael Martinez
Phone
(847) 830-6853
Address
Mount prospect
Relationship
Friends

Name
Chris Reyes
Phone
(773) 704-7399
Address
Chicago
Relationship
Friends

Name
Cristina
Phone
(630) 988-4661
Address
Chicago
Relationship
Coworker
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?  
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
Fabiola Alonso-Huerta

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
July 23, 2019
This application has been submitted and can no longer be edited.