Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Charles Daniel Robbins
Created: 08/30/2019
Other names under which employment may be verified:  
Updated: October 23, 2019

Home Address
Street Address
4915 North Nottingham Avenue
Unit/Suite Number
City ST/Zip
Chicago, IL 60656
Home Phone
Mobile Phone
317-374-2490
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $13.00/hr. or negotiable
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
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  BrightStar Care

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.

By going above and beyond expectations and by providing superior care and making someones day better and brighter for him or her. I have had extensive experience, working with the elderly and I enjoy it a lot. I prefer to do this long-term and have been doing this line of work, all of my life basically.

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

I used to care for an elderly client of mine, who was also a friend of mine and we used to work together in the past. He required more medical care and that was the main reason why my job had ended. It was a 24/7 type of job, though and I enjoyed doing it. That was awhile back though, but I still remember it.

Availability

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

Education

High School   Ben Davis High School
Location:   Indianapolis, Indiana
Did you graduate?   Yes
Subjects Studied   (Education), Science, English, Writing

College   Ultimate Medical Academy
Location:   Clearwater, Florida
Did you graduate?   Yes
Degree:   Associate's

Other:   International Career Institute
Location:   Lincolnwood, Illinois
Did you graduate?    Yes
Degree:   Basic Nursing Assistant Certification

Special awards you earned or courses you have taken.
Certified Nursing Assistant, Pharmacy Technician Certification and License, Employee of the month, Honors, High recognition awards in school, and I made the Dean's List

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Public Partnerships
Phone
(855) 243-8775
Address

40 North Broad Street
Boston, MA 02109

Supervisor
Sheila Kierney
Job Title
Caregiver
Salary or Rate of Pay
$9.66
Responsibilities
I assisted an elderly client of mine, and it was a live-in type, care position. I bathed him, lifted him out of bed, transferred to wheelchair, errand ran for him, transported him in a bus to the doctor, and I cooked and cleaned for him
From
12/01/2010
To
02/01/2012
Reason for Leaving
My job ended, because my client required more medical care and I am not an RN. I wish I was, though or an LPN
May we contact this employer?  Yes

Company Name
Brownsburg Nursing Home
Phone
(317) 852-3123
Address

1010 North Hornaday Road
Brownsburg, IN 46112

Supervisor
Carol Lamar
Job Title
Housekeeper and Laundry Department Aide
Salary or Rate of Pay
$8.80
Responsibilities
Sanitized rooms, assisted the C.N.A.'s with meal trays at times, companionship, listening ear, transporting duties, floor care and other cleaning related duties
From
08/01/2007
To
03/13/2009
Reason for Leaving
I left to relocate to Florida
May we contact this employer?  Yes

Company Name
BrightStar Care
Phone
(708) 456-6976
Address

7504 West Grand Avenue
Elmwood Park, IL 60707

Supervisor
Monica Del-Angel and Jessie (Her husband are the owners of this particular franchise location)
Job Title
Caregiver, C.N.A.
Salary or Rate of Pay
12.36
Responsibilities
Assist the elderly in their own homes, by providing medication reminder assistance, lifting, hygiene assistance cleaning, toiletry duties, cleaning of their own home, transportation at times as well
From
07/07/2017
To
Reason for Leaving
I still am working there.
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.
Any gaps, were due to being in school or looking for other employment positions. I also had to relocate at times too!
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
Carol Lamar
Phone
317-707-4213
Address
1010 North Hornaday Road, Brownsburg, IN 46112
Relationship
Prior Supervisor

Name
Jo Rotunno
Phone
773-725-7406
Address
3505 North Neva Avenue, Chicago, IL
Relationship
My current clients' son

Name
Mitchell Ton
Phone
317-435-5929
Address
Indiana
Relationship
Personal friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I am a hardworking, serious individual and I take my work serious. My clients' whom I work for now, will tell you that. I am currently employed right now, working about 32 hours, but looking for more work mainly and trying to even do a live-in type career at some point. I just need more hours is all or shifts and I can't leave where I am immediately. I would always give notice and I have worked where I am at, for over two years now too.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
Any gaps, were due to being in school or looking for other employment positions. I also had to relocate at times too!
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
Charles Daniel Robbins

PART FIVE – APPLICATION SUBMISSION

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