Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
DOREEN ANDERSON
Created: 08/30/2019
Other names under which employment may be verified:  
Updated: September 12, 2019

Home Address
Street Address
6624 104th Place
Unit/Suite Number
6
City ST/Zip
Chicago Ridge, IL 60415
Home Phone
7737074360
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   $38 - 40K
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.  Gareda, LLC

How many years have you worked as a professional caregiver?  2
What percent of your previous case work has been for an agency?  100
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I bring seven years of skill sets to this industry. Five years as a Field Supervisor, with a client base varing from 200 - 120, two years as a Home Care Aide. I have worked both sides of the spectrum and have horned my skills as an effective supervisor because of my experience as a HCA. I have a passion for this industry as I believe that our senior community deserve the highest of quality care and preservation.

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

As a caregiver, I have had the joy of taking care of my mother going thru cancer and my godparents, who are both still living independently at the young age of 88. Those experiences of taking care of people that I love were invaluable to me,.

Availability

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

Education

High School   Lindblom Technical
Location:   Chicago Illinois
Did you graduate?   Yes
Subjects Studied   College Preparatory

College   MacCormac College
Location:   Chicago Illinois
Did you graduate?   No
Degree:   Certification

Other:   Vogue Beauty School
Location:   Chicago Illinois
Did you graduate?   
Degree:   License

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
Gareda, LLC
Phone
844-277-5722
Address

1431 Huntington Drive
Calumet City, IL 60409

Supervisor
Deborah Rhymes
Job Title
Home Care Aide
Salary or Rate of Pay
12 hour
Responsibilities
Provided non-medical services to the elderly and disabled, Cooked appetizing and nutritional meals. Assist clients with mobility issues. Perform household duties and saome errands for some clients.
From
01/07/2013
To
01/05/2015
Reason for Leaving
Upgrade to full-time position.
May we contact this employer?  Yes

Company Name
Assyrian Universal Alliance Foundation
Phone
773-274-9262
Address

4343 W. Touhy Avenue
Lincolnwood, IL 60712

Supervisor
Mike Toya
Job Title
Manager
Salary or Rate of Pay
39,600K
Responsibilities
Travel throughout the service area to conduct visits at clients's residence, monitors and reports to the Director of CCP Program on the quality of service provided the HCA
From
09/15/2014
To
07/22/2019
Reason for Leaving
My transportation became compromised and I was not able to perform the job.
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
Chyrisse Bailey
Phone
773-418-7372
Address
Chicago, IL
Relationship
Friend

Name
Mike Toya
Phone
312-498-5081
Address
Skokie IL
Relationship
Friend

Name
Tonya Coleman-McKay
Phone
773-263-0165
Address
Oak Lawn IL
Relationship
Friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I am very passionate about this industry and truly enjoy working with the senior and elderly community. I am a careagiver by nature and working in this industry allows the opportunity to give back to a community that this country has forgotten.

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?  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
DOREEN ANDERSON

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
August 31, 2019
This application has been submitted and can no longer be edited.