Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Aurora Lucero
Created: 09/04/2019
Other names under which employment may be verified:  
Updated: September 5, 2019

Home Address
Street Address
4541 N. Sheridan Road.
Unit/Suite Number
City ST/Zip
Chicago, IL 60640
Home Phone
3124509522
Mobile Phone
3124509522
Alternate Phone
3124509522

Have you ever worked for us before?   No
If no, how did you hear about us? Through friends like Florida Narvades
Rate of pay desired.   18 per hour
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
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   english, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Custom Home Care

How many years have you worked as a professional caregiver?  11
What percent of your previous case work has been for an agency?  50
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I am very hardworking, compassionate, understanding and can get along well with co- workers and clients, I have a lot of patience which I think is very important in working with the elderly.

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

I once had a client with severe dementia. She would always get confused and agitated. I would always be able to calm her down .

Availability

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

Education

High School   Pio del Pilar High School
Location:   Manila, Philippines
Did you graduate?   Yes
Subjects Studied   general

College   
Location:   
Did you graduate?   
Degree:   

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
Visiting Angels
Phone
847-424-9300
Address

518 Davis St.
Evanston , IL

Supervisor
Kelly
Job Title
Caregiver
Salary or Rate of Pay
110 a day
Responsibilities
Med reminder, housekeeping. ADL assist, meal prep, personal care and grooming
From
05/04/2011
To
09/11/2013
Reason for Leaving
Client moved
May we contact this employer?  Yes

Company Name
Virginia Boyle
Phone
708-562-3482
Address

1826 Belleview Ave
West Chester, IL

Supervisor
Private
Job Title
Caregiver
Salary or Rate of Pay
$150 a day
Responsibilities
ADL assist, meal prep, housekeeping, med reminder, personal hygiene
From
07/17/2014
To
01/03/2019
Reason for Leaving
Client needs heavy lifting already
May we contact this employer?  Yes

Company Name
Custom Home Care
Phone
773-561-4663
Address

2716 Peterson Ave
Chicago,Illinois
60659

Supervisor
Matthew Baldwin
Job Title
Caregiver
Salary or Rate of Pay
$169 a day
Responsibilities
activities of daily living assistance, medreminder, meals preparation, personal grooming
From
01/15/2019
To
Reason for Leaving
Still working
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.
I go and visit the Philippines during those gaps.
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
Florida Narvades
Phone
773-850-7509
Address
4428 N Central Ave, Chicago, IL 60630
Relationship
friend

Name
Mary Smith
Phone
708-638-7551
Address
1812 Manschester Ave Westche ster, IL 60154
Relationship
Client’s daughter

Name
Rosalinda Reardon
Phone
773-603-5694
Address
4736 N Malden Ave Chicago, IL 60640
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.
I go and visit the Philippines during those gaps.
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
Aurora Lucero

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
September 5, 2019
This application has been submitted and can no longer be edited.