Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Ramonette Mahinay
Created: 05/29/2019
Other names under which employment may be verified:  
Updated: June 13, 2019

Home Address
Street Address
5908 W EASTWOOD AVE
Unit/Suite Number
City ST/Zip
CHICAGO, IL 60630
Home Phone
7739688271
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $18.00 - $20.00
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, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  LLP Health Care Services of Illinois

How many years have you worked as a professional caregiver?  2
What percent of your previous case work has been for an agency?  50
Please explain how you will contribute to strengthen the Water Tower Nursing team.

An enthusiastic Registered Nurse in the Philippines with sound understanding of technical support and medical duties. A person that is goal-directed, results oriented, persuasive and adaptable. Maintain keen insight into the needs and views of others.

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

Several years ago, I have taken care of a 80 yo client in California who was recuperating from a vehicular accident. Because of my care, she was able to recover gradually and slowly she was able to do ADL's on her own.

On Sundays, I take care of a 97 yo female client. I help and assist her in her ADL's.

Availability

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

Education

High School   Colegio de la Immaculada Concepcion
Location:   Cebu City, Philippines
Did you graduate?   Yes
Subjects Studied   High School

College   Colegio de San Antonio de Padua
Location:   Danao City, Cebu, Philippines
Did you graduate?   Yes
Degree:   Bachelor of Science in Nursing

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
Cebu Mitsumi Inc
Phone
(032) 417 - 0001
Address

Danao City, Cebu, Philippines

Supervisor
Caesar D. Agusto
Job Title
Office Staff
Salary or Rate of Pay
$400.00 / month
Responsibilities
HR administrative staff
From
07/16/1994
To
12/31/2004
Reason for Leaving
Ventured in business
May we contact this employer?  Yes

Company Name
Danao City General Hospital
Phone
N/A
Address

Danao City, Cebu, Philippines

Supervisor
Estalina S. Bacon
Job Title
Volunteer Registered Nurse
Salary or Rate of Pay
NONE
Responsibilities
Triage patients, vital signs taking, medication administration, admit patients with MD orders
From
09/01/2010
To
12/28/2012
Reason for Leaving
Only volunteered for 2 years
May we contact this employer?  Yes

Company Name
Danao City Government, Philippines
Phone
(01163) 916 486 8620
Address

Danao City, Cebu, Philippines

Supervisor
Dana Canson
Job Title
Department Head - Public Information Office
Salary or Rate of Pay
$1,584 / month
Responsibilities
Be the face of the government organization in the absence of an elected leader. Respond to request for information from media outlet and to constituents. Help maintain and uphold a certain image and identity for the government officials and the entire organizations. Responsible for organizing special events, such as news, conferences, awards and other ceremonies.
From
06/03/2013
To
02/20/2018
Reason for Leaving
Relocated to the United States
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.
Ventured in Business
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
Karen Ferkau, PA-C
Phone
(312) 401 - 0127
Address
Chicago, IL
Relationship
Daughter of previous client in caregiving

Name
Juanita g. Arcenal
Phone
(773) 817 -7688
Address
Orland Park, IL
Relationship
Friend

Name
Teresa Hyrc
Phone
(773) 807 - 5137
Address
Des Plaines, IL
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.
Ventured in Business
Additional Certifications
Registered Nurse in the Philippines

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
Ramonette Cynthia Mahinay

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
May 30, 2019
This application has been submitted and can no longer be edited.