Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Analyn Addie Mendoza
Created: 11/05/2019
Other names under which employment may be verified:  
Updated: November 14, 2019

Home Address
Street Address
4650 N. Springfield Ave
Unit/Suite Number
City ST/Zip
Chicago, IL 60625
Home Phone
Mobile Phone
2242819664
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us? REFERRAL
Rate of pay desired.   $13
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
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'd be a great asset to the team by effectively catering to the client's needs in a compassionate and professional manner. I have strong interpersonal skills that will allow me to establish a trusted relationship with my clients through open communication which is necessary for providing an excellent service. I have clear understanding of the importance of home safety and the ability to function well in a home setting. Under operating from instructions, I'm also comfortable in taking initiative in being proactive and making informed decisions during take-action circumstances.

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

Provided care and assistance as a private, live-in caregiver and companion. Primarily focused on assistance with personal hygiene, mobility, and transport.

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   Von Steuben Metropolitan Science Center
Location:   Chicago, Illinois
Did you graduate?   Yes
Subjects Studied   

College   Truman College
Location:   Chicago, Illinois
Did you graduate?   Yes
Degree:   Associates

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
Phone
(312)-343-0375
Address
Supervisor
NICOLE ORENDAIN
Job Title
PRIVATE LIVE-IN CAREGIVER
Salary or Rate of Pay
$15
Responsibilities
Primarily focused on assistance with transport, mobility, and administering personal hygiene
From
09/27/2017
To
02/07/2018
Reason for Leaving
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 left the work force as a full-time student to focus on my studies
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
Kyle Westbrooks
Phone
(773)-230-4328
Address
4648 N. Springfield Ave
Relationship

Name
Abdul Zaheed
Phone
(312)-868-5693
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.
I left the work force as a full-time student to focus on my studies
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
Analyn

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
November 11, 2019
This application has been submitted and can no longer be edited.