Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Lovell Mahinay
Created: 05/29/2019
Other names under which employment may be verified:  
Updated: June 28, 2019

Home Address
Street Address
5908 W Eastwood Ave.
Unit/Suite Number
City ST/Zip
Chicago, IL 60630
Home Phone
5105139827
Mobile Phone
5105139827
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
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   english, tagalog
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?  1
What percent of your previous case work has been for an agency?  1
Please explain how you will contribute to strengthen the Water Tower Nursing team.

Will provide assistance to individuals who needs health, physical and emotional support. Definitely a good care giver who is compassionate, patient, understanding, and trustworthy.

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

Several years ago, took care of a 85 yo client for companionship and help with 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   Danao Visayan Institute
Location:   Danao City, Cebu
Did you graduate?   Yes
Subjects Studied   

College   University of San Jose Recoletos
Location:   Cebu City, Philippines
Did you graduate?   Yes
Degree:   Bachelor of Science in Electronics and Communications Engineering

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, Philippines

Supervisor
Caesar D. Agusto
Job Title
Production Engineer
Salary or Rate of Pay
$500.00 / month
Responsibilities
Ensures that production lines meet and sustain productivity, and yield requirements by eliminating causes of special variations to Man, Machine, Method and Materials (4M's). Enforcing adherence pf production processes to established productions systems and standards. Monitoring of process cycle time and identifying inefficiencies and difficulties in the process to ensure line balance.
From
05/16/1995
To
07/28/2006
Reason for Leaving
Ventured in business
May we contact this employer?  Yes

Company Name
Danao City Government, Philippines
Phone
NA
Address

Danao City, Philippines

Supervisor
NA
Job Title
City Councilor Man
Salary or Rate of Pay
$1,800 / month
Responsibilities
Act as the legislative branch of the city government, as well as its policy making body. The council also looks to the city's goals, major projects and infrastructure improvement ranging from community growth to land use to finances and strategic planning.
From
07/04/2016
To
02/23/2018
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 and became a City Councilor
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
Edmel Padernos
Phone
773 - 818 - 0028
Address
Round Lake, IL
Relationship
Friend

Name
Efrain Santiago
Phone
773 - 603 - 0676
Address
Chicago, IL
Relationship

Name
Teresa Hyrc
Phone
773 - 807 - 5137
Address
Des Plaines, IL
Relationship
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 and became a City Councilor
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)
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
Lovell Mahinay

PART FIVE – APPLICATION SUBMISSION

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