Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Vrunda Patel
Created: 07/23/2019
Other names under which employment may be verified:  
Updated: August 13, 2019

Home Address
Street Address
239 Faircroft Rd
Unit/Suite Number
City ST/Zip
Bartlett, IL 60103
Home Phone
16307762556
Mobile Phone
6307762556
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? online search
Rate of pay desired.   13.50
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
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?  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.

I have had experience providing care for many different kinds of people ranging from the developmentally disabled to the elderly. Throughout my experience I have been able to gain many skills such as patience, empathy, the ability to work in a team and many other similar traits.

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

I have worked as a care giver in a home for the developmentally disabled, providing basic care. I have also worked in an assisted living home for the elderly.

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   James B Conant High School
Location:   Hoffman Estates, Illinois
Did you graduate?   Yes
Subjects Studied   

College   Loyola University
Location:   Chicago, Illinois
Did you graduate?   No
Degree:   Health Systems Management

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
I have a certified nursing assistant license and have taking many healthcare courses in high school such as medical terminology and anatomy and physiology

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Victory Center of Bartlett
Phone
6305040369
Address

1101 W Bartlett Rd, Bartlett, IL 60103

Supervisor
Melissa Trejo
Job Title
Life Enrichment Aide
Salary or Rate of Pay
$12.50
Responsibilities
providing basic care and assistance to the elderly
From
06/01/2018
To
07/23/2019
Reason for Leaving
N/A I am still employed for this company and am looking for a job closer to school in chicago
May we contact this employer?  Yes

Company Name
Marklund
Phone
6303071882
Address

164 S Prairie Ave, Bloomingdale, IL 60108

Supervisor
Rose Holod
Job Title
Certified Nursing Assistant
Salary or Rate of Pay
$14.00
Responsibilities
Providing basic care and attention to the residents
From
06/01/2018
To
01/01/2019
Reason for Leaving
personal family issues had risen at the time
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
Shivani Patel
Phone
6308089653
Address
230 W Berkley Ln
Relationship
Friend

Name
Gargee Pandya
Phone
2243347987
Address
1212 Salford Dr
Relationship
Friend

Name
Vraj Kharvari
Phone
8472841920
Address
469 oak tree cir
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?  
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
Vrunda Patel

PART FIVE – APPLICATION SUBMISSION

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