Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Brankica Knezevic
Created: 08/27/2019
Other names under which employment may be verified:  Bella
Updated: September 5, 2019

Home Address
Street Address
3018 W. Palmer Blvd
Unit/Suite Number
City ST/Zip
Chicago , IL 60647
Home Phone
7738591037
Mobile Phone
773-859-1037
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Refereed by friend
Rate of pay desired.  
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
No
Dogs
Yes
Smoker
No
What languages do you speak?   english, spanish
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?  5
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.

As a team player, always providing high-quality care, communicating with patients and co-workers is essential to getting Job done right and improving patients health. Respecting my co-workers and team.Keeping charts and notes during my work shift and verbally and clearly communicate every important detail. Always providing the best possible care and always making sure that my patients well being and safety is my #1 priority .

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

Caregiving for a man in his late 70’s who had cancer and also suffered a stroke and a heart attack. My duties included assistance with personal morning care, grooming , dressing , and feeding . Daily exercise , taking patient to the balcony or outside for sunshine and fresh air. Reading books and newspaper to the patient. Talking and listening and keeping patient company. Playing cards and board games and watching tv with the patient. Basic cooking but always healthy and nutritious. Medication management, made doctor’s appointments when needed, tidying around the apartment and cleaning the kitchen after meal prep. Loading and unloading dishwasher and making sure my patient always had the pantry stocked with food he needed. Ordered and received groceries.

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   4 yrs
Location:   Chicago IL
Did you graduate?   Yes
Subjects Studied   

College   NEIU
Location:   Chicago IL
Did you graduate?   
Degree:   Business

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
Adele Vydra
Phone
312-782-1406
Address

900 N. Lake Shore Dr. chicago. il

Supervisor
Job Title
Caregiver
Salary or Rate of Pay
$1,500 weekly
Responsibilities
Dressing the patient in the morning , groomkng, feeding brakfast, reading to patient,managed his medication, walked him and took him outside when he was well enough, placed him in bed to watch tv , read books and newspapers to him, prepared lunch and fed him , did light house work made sure place was clean . Washes dishes , and cleaned kitchen after I prepped and cooked meals . Made sure bathroom was clean and bed sheets were changed. Made sure patient had enough food supplies and took notes throughout the day regarding patient daily food intake , exercise , sleep , meds and overall behavior and symptoms
From
To
Reason for Leaving
The patient passed
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.
Between February of 2017 and present I have been a caregiver for my mom who just recently moved back to Europe
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
Juan Gonzalez
Phone
773-329-5930
Address
6105 N. Karlov
Relationship
Friend

Name
Isabel Garza
Phone
224-735-0800
Address
Glenview,Il
Relationship
Friend

Name
Nikki Dobric
Phone
773-679-5659
Address
Chicago,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.
Between February of 2017 and present I have been a caregiver for my mom who just recently moved back to Europe
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
Brankica Knezevic

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
August 28, 2019
This application has been submitted and can no longer be edited.