Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Bettye jo Hester
Created: 08/07/2019
Other names under which employment may be verified:  
Updated: August 12, 2019

Home Address
Street Address
1553 west 90th street
Unit/Suite Number
Apt 304
City ST/Zip
Chicago, IL 60620
Home Phone
7735845563
Mobile Phone
7735845563
Alternate Phone
7735845563

Have you ever worked for us before?   No
If no, how did you hear about us? internet
Rate of pay desired.   15.00 hourly
Do you have a valid driver’s license?   No
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?  Yes
If yes, explain.  Addus home care

How many years have you worked as a professional caregiver?  15
What percent of your previous case work has been for an agency?  6
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I will come into the Water Tower Nursing team with the ability to give your clients the best care possible. To help them feel comfortable in there home. And to help them with all there daily living care. And bring a cheerful attitude at all times.

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

Taking care of my parents when they where ill, is the same care I will give each and every client that I am responsible to care for. Treating them with all the respect and dignity they require and deserve.

Availability

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

Education

High School   Chicago Vocational High School
Location:   Chicago, Illinois
Did you graduate?   Yes
Subjects Studied   Major studies

College   Kennedy King College
Location:   Chicago, Illinois
Did you graduate?   Yes
Degree:   Certified Nursing Assistant

Other:   Ultimate Medical Academy
Location:   Tampa, Florida
Did you graduate?    No
Degree:   Medical Administrative Assistant

Special awards you earned or courses you have taken.
Honors awards, MT certificate, HIPAA certificate.

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Addus home care
Phone
7733965600
Address

2335 95th st.
Chicago, Illinois
60643

Supervisor
Ms. pitts
Job Title
Homecare aide
Salary or Rate of Pay
13.50
Responsibilities
Help clients with daily living inside there home. Also ran errands for the clients.
From
05/13/2015
To
11/16/2017
Reason for Leaving
Job with beneifts
May we contact this employer?  Yes

Company Name
The Clare
Phone
3127848100
Address

55 east Pearson street
Chicago, Illinois
60611

Supervisor
Melvenna
Job Title
Certified Nursing assistant
Salary or Rate of Pay
14.42 hourly
Responsibilities
Took care of patients in a nursing home setting. Helping with daily living.
From
12/27/2017
To
07/24/2019
Reason for Leaving
Discharged
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
Rahki Vig
Phone
9097627251
Address
Relationship
Employer

Name
Joe Butler
Phone
3124027487
Address
Relationship
Employer

Name
Kim Boone
Phone
7739949682
Address
Relationship
friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

Thank you for your time. And I hope I'm consider for a position with your company. Have a great day.

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)
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
Bettye jo Hester

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
August 7, 2019
This application has been submitted and can no longer be edited.