Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Princess Ladawn McNeal
Created: 07/29/2019
Other names under which employment may be verified:  
Updated: July 29, 2019

Home Address
Street Address
8826 S Washtenaw Ave
Unit/Suite Number
City ST/Zip
Evergreen Park, IL 60805
Home Phone
6305444187
Mobile Phone
6305444187
Alternate Phone
6305444187

Have you ever worked for us before?   No
If no, how did you hear about us? Friend
Rate of pay desired.   $15.00
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
No
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.  Comfort Keepers

How many years have you worked as a professional caregiver?  4
What percent of your previous case work has been for an agency?  25
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I would strengthen WTN by being on time, greet with a smile, have a listening ear, take pride in my work, and provide quality care.

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

Made a resident happy by purchasing a no rinse shampoo cap because she stated "I would do anything to have my hair washed.

Availability

Days   Yes
Nights   Yes
Weekdays   Yes
Weekends   Yes
Live-in   Yes
Can you travel outside the city of Chicago to work?   Yes

Education

High School   Calumet
Location:   Chicago, IL
Did you graduate?   Yes
Subjects Studied   General

College   National Louis University
Location:   Chicago, IL
Did you graduate?   Yes
Degree:   Bachelor

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
Comfort Keepers Home Care
Phone
630-313-2242
Address

185 Hansen Ct #120
Wood Dale IL 60191

Supervisor
Linda
Job Title
Supervisor
Salary or Rate of Pay
$10.00
Responsibilities
Provide Quality Care to all clients.
From
01/04/2016
To
12/30/2016
Reason for Leaving
Needed more hours.
May we contact this employer?  Yes

Company Name
Lexington Square Retirement Community
Phone
630-832-9922
Address

400 W Butterfield Road
Elmhurst, IL 60126

Supervisor
Gilda
Job Title
Supervisor
Salary or Rate of Pay
$11.00
Responsibilities
Provide Quality Care to all residents.
From
08/01/2016
To
02/27/2017
Reason for Leaving
Needed to be closer to home.
May we contact this employer?  Yes

Company Name
Lombard Place Assisted Living & Memory Care
Phone
630-953-7472
Address

300 W 22nd Street
Lombard, IL 60148

Supervisor
Ashley
Job Title
Supervisor
Salary or Rate of Pay
$10.50
Responsibilities
Provide Quality Care to all residents.
From
03/06/2017
To
03/30/2018
Reason for Leaving
Better Pay
May we contact this employer?  Yes

Company Name
Warren Barr Living & Rehabilitation Center
Phone
312-705-6700
Address

66 West Oak
Chicago, IL 60610

Supervisor
Stacy
Job Title
LPN
Salary or Rate of Pay
$14.56
Responsibilities
Provide Quality Care to all patients.
From
06/04/2018
To
Reason for Leaving
Present
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.
My mother was ill therefore I provided care.
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
Rasmey Loek
Phone
312-316-6428
Address
Rasmey.loek@wbp-hp.com
Relationship
Co-worker/friend

Name
Janet Bandur
Phone
630-346-8957
Address
1311 Daly Road
Relationship
Co-worker/friend

Name
Linda Asani
Phone
630-461-4184
Address
818 N 14th Ave
Relationship
Friend
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.
My mother was ill therefore I provided care.
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
Princess Ladawn McNeal

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
July 29, 2019
This application has been submitted and can no longer be edited.