Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Keana Marcia Barbosa
Created: 10/28/2019
Other names under which employment may be verified:  
Updated: October 28, 2019

Home Address
Street Address
11351 s langley
Unit/Suite Number
City ST/Zip
Chicago, IL 60628
Home Phone
3124814567
Mobile Phone
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   15.00
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.  Help at home

How many years have you worked as a professional caregiver?  6
What percent of your previous case work has been for an agency?  4
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I am a dedicated home healthcare aide who is passionate about contributing to physical development of clients. Enthusiastic, creative and caring, versed in healthcare practices and seeks to provide exceptional quality care.

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

I had a Alzheimer's patient I was giving service to and every morning it was a challenge to get her out of bed the first two days working for her. The third day I knew I had to come up with a strategy to get her out of bed on time. She loved her some bacon and grits so I would tell her the quicker you get out of bed you could have breakfast and since then it made it easier with working with her to get her out the bed

Availability

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

Education

High School   Harlan
Location:   Chicago Illinois
Did you graduate?   Yes
Subjects Studied   Science

College   Olive harvey
Location:   Chicago Illinois
Did you graduate?   No
Degree:   None

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
Help at home
Phone
7739027373
Address

1 N state

Supervisor
Connolly
Job Title
Manger
Salary or Rate of Pay
13.00
Responsibilities
Assisting with personal care, which may include bathroom functions, bathing, grooming, dressing, and eating. Following a prescribed healthcare plan, which may include assisting with exercise and administering medication. Ensuring the client’s home is organized according to their needs and that safety measures are in place. You may also be expected to assist with some light housework. Providing emotional support and encouragement to perform necessary tasks. Providing mobility assistance may be required, for example helping the client in and out of bed, a chair, or a wheelchair. Transporting or escorting the client to medical and other appointments. Monitoring and reporting changes in health, behavior, and needs.
From
09/05/2018
To
10/28/2019
Reason for Leaving
Current
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
Phone
Address
Relationship

Name
Phone
Address
Relationship

Name
Phone
Address
Relationship
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 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
Keana Barbosa

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
October 28, 2019
This application has been submitted and can no longer be edited.