Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Aksana Pesniak
Created: 09/23/2019
Other names under which employment may be verified:  
Updated: October 26, 2019

Home Address
Street Address
333 E Ontario
Unit/Suite Number
apt 3701
City ST/Zip
Chicago, IL 60611
Home Phone
Mobile Phone
3123587107
Alternate Phone
7732363122

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   30
Do you have a valid driver’s license?   Yes
Do you have access to a car? No

I am able to work client who has or lives with:
Family
Yes
Hospice
No
Cats
Yes
Dogs
Yes
Smoker
No
What languages do you speak?   english
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?  2
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've had tragic deaths in my family which required nursing where I was the nurse.
I did all things necessary to be close to my relatives and make them feel cared for and loved with little time they had.
Some people don't have anyone to care for them they get older due to different circumstances and it is a tragedy. I am a pretty compassionate person who finds fulfillment to be the person who is around people in their time of need.

I am a legal immigrant from Belarus who speaks Russian fluetly - able to serve clients from post-Soviet republics.

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

I worked as a caregiver in 2017-2018 in Germany near Munster city.I looked after an old lady Natalie Holleveg.I did her laundry,prepared meals,did grosery shopping,did massage,took her for a walk and went to the swimming pool.

Availability

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

Education

High School   High School #42
Location:   Minsk, U.S.S.R.
Did you graduate?   Yes
Subjects Studied   Math,anatomy,basic medical training,biology,chemistry,physics,history,geography,Russian and English languages,

College   BELARUSIAN ECONOMIC UNIVERSITY
Location:   MINSK, U.S.S.R.
Did you graduate?   Yes
Degree:   Economics and Finance

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
Certificate №5-499"School of remedial massage" in Belarusian State University of Physical Culture

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Prado LLC
Phone
+375291000055
Address

Herzena 2A, Minsk, Belarus

Supervisor
Tatiana Denisova
Job Title
Chief Accountant
Salary or Rate of Pay
20000
Responsibilities
Internal Accounting
From
09/08/1992
To
09/15/2019
Reason for Leaving
Immigration to the U.S.A.
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 present
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
Alik Doubovik
Phone
8474086164
Address
1311 W Chicago Ave 4
Relationship
Business partner

Name
Tanya Filek
Phone
8479519134
Address
905 W Castlewood Drive
Relationship
Business partner

Name
Anya Boyarintsova
Phone
3128718949
Address
4909 N Pulaski
Relationship
Employee
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.
No gaps present
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
Aksana Pesniak

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
October 27, 2019
This application has been submitted and can no longer be edited.