Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Merlina Neri Tippit
Created: 06/02/2019
Other names under which employment may be verified:  
Updated: August 12, 2019

Home Address
Street Address
5606 High Timber Lane
Unit/Suite Number
City ST/Zip
Indianapolis, IN 46235
Home Phone
Mobile Phone
317-512-2576
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? acquaintance friend
Rate of pay desired.   live-in rate
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
No
Hospice
No
Cats
No
Dogs
No
Smoker
No
What languages do you speak?   
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?  7
What percent of your previous case work has been for an agency?  98
Please explain how you will contribute to strengthen the Water Tower Nursing team.

As a person and caregiver is to be reliable and respectful to every client and to the agency i working with.

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

I have more years working/caring with Alzheimer,some are early parkinson,light stroke,diabetic and dementia cases.

Availability

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

Education

High School   
Location:   
Did you graduate?   No
Subjects Studied   

College   Mindanao State University
Location:   Iligan City-Philippines
Did you graduate?   Yes
Degree:   Diploma in civil Engineering Technology

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
Samland home care
Phone
773-329-0955
Address

Chicago,IL

Supervisor
Beth Landicho
Job Title
cna/caregiver
Salary or Rate of Pay
Responsibilities
personal care,prepare meals,incontinence,remind med,assists exercise and light house keeping
From
02/10/2012
To
05/20/2016
Reason for Leaving
out of business
May we contact this employer?  Yes

Company Name
Self-employed
Phone
847-470-8053
Address

Niles,IL

Supervisor
Cher Melone employer's daughter
Job Title
caregiver
Salary or Rate of Pay
Responsibilities
prepare meals,remind med,errands,personal care and light house keeping.
From
08/10/2015
To
10/20/2017
Reason for Leaving
client is passed away
May we contact this employer?  Yes

Company Name
Home Angels
Phone
847-826-0119
Address

2720 S River Rd Des Plaines,IL 60018

Supervisor
Joyce
Job Title
Caregiver/cna
Salary or Rate of Pay
Responsibilities
remind med,personal care,prepare meals and light house keeping
From
06/20/2014
To
08/18/2017
Reason for Leaving
client moved to facility
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
Beth Landicho
Phone
773-329-0955
Address
chicago,Il
Relationship
friend/staff coordinator of Samland

Name
Aurora Lucero
Phone
312-450-9522
Address
Chicago,IL
Relationship
friend

Name
Michael Bruno
Phone
Address
Niles,IL
Relationship
employers' son
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I moved in Indianapolis and working part time only. I am now decided to come back to chicago to work full time live in caregiver.
i am available to work on 2nd week of June if hired but i need early notification so i able to accept a new assignment.Thank you
and have a great day.

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)
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
Merlina Tippit

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
June 2, 2019
This application has been submitted and can no longer be edited.