Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Jen Martin Martin
Created: 08/28/2019
Other names under which employment may be verified:  Jennifer Martin
Updated: August 28, 2019

Home Address
Street Address
1158 ashlyn lane
Unit/Suite Number
City ST/Zip
Antioch, IL 60002
Home Phone
8154511278
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
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
No
Smoker
No
What languages do you speak?   english, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Arden Rose

How many years have you worked as a professional caregiver?  10
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 always make sure that when I take care of our clients,it is always exactly how I wanted to be taken care of. I handle my clients with a kind heart and caring hands.

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

I've had handled several clients and I would say that the client I have with ALS is the most challenging one,where your clients cannot Express how he wanted things done because he lost his speech and he is paralyzed. He is one of my most challenging case but I handled it with compassion and real understanding of his condition.

Availability

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

Education

High School   University of Perperual Help
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   English

College   University of Perpetual Help
Location:   Philippines
Did you graduate?   No
Degree:   4 yrs college

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

Please update your application with your employment history. No employment history found.
 

REFERENCES & ACCEPTANCE

Thank you for entering your employment history in Part Two. Before proceeding, could you please explain any gaps in your work history.
Personal 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
Grace Cruz
Phone
6302679479
Address
Schaumburg IL
Relationship
Coworker

Name
Rosibeth Hernandez
Phone
2244022859
Address
Elgin IL
Relationship
Business

Name
Marilyn Palazzo
Phone
8155820306
Address
St.Charles
Relationship
Business
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.
Personal Business
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
Jen Martin

PART FIVE – APPLICATION SUBMISSION

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