Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Janet Ochieng
Created: 11/06/2019
Other names under which employment may be verified:  N/A Same As Above
Updated: November 6, 2019

Home Address
Street Address
P.O. Box 5071
Unit/Suite Number
City ST/Zip
Raleigh , NC 27650
Home Phone
9195324049
Mobile Phone
9195324049
Alternate Phone
9197571491

Have you ever worked for us before?   No
If no, how did you hear about us? Mr Mathews H
Rate of pay desired.   $25 And Above per Hour or Negotiable
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
No
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  North Carolina

How many years have you worked as a professional caregiver?  20
What percent of your previous case work has been for an agency?  1
Please explain how you will contribute to strengthen the Water Tower Nursing team.

Working As A Team. Willing to Learn. Open to Constructive Criticism that's intended to the Client benefits. I encourage communication..take good care of the Client

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

I have learned to listen to what the Client wants. Follow instructions. To loving and caring. Not to be overly controlling but to work out as a team.

Availability

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

Education

High School   Abroad
Location:   
Did you graduate?   Yes
Subjects Studied   Basics

College   
Location:   
Did you graduate?   
Degree:   

Other:   CNA 1
Location:   Raleigh NC
Did you graduate?    Yes
Degree:   CNA 1

Special awards you earned or courses you have taken.
N/A

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
The Adams Family Power Of Attorney
Phone
9196045573
Address

600 St Mary's Street. Apt # 406 Raleigh NC 27605

Supervisor
Ms June Eason
Job Title
Home Care
Salary or Rate of Pay
$ 1000 / Week
Responsibilities
Taking Care Of Dad And Mom
From
04/01/2016
To
11/15/2019
Reason for Leaving
They Both Expired
May we contact this employer?  Yes

Company Name
Mr Adams Roni & June Eason
Phone
9196045573
Address

3336 Benson Road Angier NC

Supervisor
Ms June Eason
Job Title
Home Care
Salary or Rate of Pay
$1000 / Week
Responsibilities
Taking Care Of Ms Adams
From
02/01/2017
To
11/06/2018
Reason for Leaving
Client Expired
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.
Was Taking Care Of My Children
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
June Eason
Phone
9196045573
Address
Raleigh
Relationship
Former Boss. Home Care

Name
Terry Muthama
Phone
9197983334
Address
Raleigh NC
Relationship
A Friend And A Work Mate

Name
Sarah Bright
Phone
9192150724
Address
Raleigh NC
Relationship
A Friend. Registered Nurse
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I'm A very hard working Single Parent . It's My Prayers that I Treat People The Way I'd Like to Be Treated one day. I like helping people that don't have that opportunity. I have a son who's been struggling with health issues, So I Understand. Looking forward to Working with You. Thanks

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
Was Taking Care Of My Children
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
Janet A Ochieng

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
November 7, 2019
This application has been submitted and can no longer be edited.