Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Ahemen Daniella Washima
Created: 10/15/2019
Other names under which employment may be verified:  
Updated: October 18, 2019

Home Address
Street Address
4180 North marine drive
Unit/Suite Number
Apt 410
City ST/Zip
Chicago , IL 60613
Home Phone
Mobile Phone
8155176749
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   14.50 per hour
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
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.  Brookdale senior living Lake shore drive. chicago IL.

How many years have you worked as a professional caregiver?  1
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 have worked as a CNA/ caregiver for about a year. i also work as a preschool teacher,. i am a natural caregiver, it comes naturally and I can not imagine doing anything else but take care of people no matter their age. I believe I will be a great addition to your team as I am hardworking, committed and passionate about serving people.

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

Availability

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

Education

High School   FederaL college Nigeria
Location:   Nigeria
Did you graduate?   No
Subjects Studied   

College   Northern Illinois university
Location:   Dekalb DeKalb il
Did you graduate?   Yes
Degree:   Early childhood education

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
Sunrise Senior living Lincoln Park
Phone
(773) 244-0005
Address

Sunrise Senior Living
2710 N. Clark
Chicago IL, 60614

Supervisor
Edwina Winton
Job Title
Care manager Supervisor
Salary or Rate of Pay
13.50
Responsibilities
Giving personal care assistance to residents.
From
06/10/2019
To
08/16/2019
Reason for Leaving
May we contact this employer?  Yes

Company Name
Brookdale Senior Living of Lake shore drive.
Phone
(773) 880-2960
Address

2960 N Lake Shore Dr, Chicago, IL 60657

Supervisor
Monica Chamberlain
Job Title
Resident Care Coordinator- LPN
Salary or Rate of Pay
14.50
Responsibilities
Assisting Residents with daily living activities like showers, Medication reminders, escort to hospital appointments and help at meal times.
From
03/01/2019
To
10/18/2019
Reason for Leaving
Still work 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.
There are no gaps in my work history since acquiring my CNA certificate.
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
Kelly Ogemdi
Phone
312 619 0500
Address
6106 South University avenue
Relationship
Friend

Name
Member Abarshi
Phone
352 507 9906
Address
500 Witchazel street, Aberdeen, MD
Relationship
sister

Name
Ngozi Onuoha
Phone
404 604 1771
Address
701 West Belmont Apt 3e, chicago IL
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.
There are no gaps in my work history since acquiring my CNA certificate.
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
Ahemen Washima

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
October 18, 2019
This application has been submitted and can no longer be edited.