Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
olaide veronica nduka-nwajei
Created: 11/13/2019
Other names under which employment may be verified:  nduka-ferguson
Updated: November 19, 2019

Home Address
Street Address
14810 champlain avenue
Unit/Suite Number
City ST/Zip
dolton, IL 60419
Home Phone
7735529114
Mobile Phone
7735529114
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? internet/friend
Rate of pay desired.   open
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
No
Dogs
No
Smoker
No
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  samland institute of allied health and technology

How many years have you worked as a professional caregiver?  17
What percent of your previous case work has been for an agency?  80
Please explain how you will contribute to strengthen the Water Tower Nursing team.

by working as a team member with water tower nursing team. also comply with the agency policy and help the clients/residents by providing a good care @ the comfortable of their home.

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

my experience with my job is that, my clients always loves me, because of my services and my punctuality. some times i go beyond to put a smile on my clients faces.

Availability

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

Education

High School   12
Location:   chicago,illinois
Did you graduate?   Yes
Subjects Studied   commerce/health sicence

College   2
Location:   lagos nigeria
Did you graduate?   Yes
Degree:   mass communication

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
certified in alzheier and dementia, also have a CNA certified nursing assistance

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
customhome health care
Phone
7735614663
Address

2716 W Peterson Ave, chicago.,il,60059

Supervisor
cathy
Job Title
CNA/CARGIVER
Salary or Rate of Pay
$12.00
Responsibilities
assist client with their ADL'S ETC.
From
08/15/2016
To
11/13/2019
Reason for Leaving
STILL ACTIVE BUT NO HOURS
May we contact this employer?  Yes

Company Name
brighterstar agency tinley park
Phone
7082265100
Address

9501 W 144th PL suite 303, orland park, il,60462.

Supervisor
jill/letha
Job Title
CNA/CARGIVER
Salary or Rate of Pay
$13.50
Responsibilities
assist client with their ADL'S ETC.
From
05/08/2018
To
11/13/2019
Reason for Leaving
still active
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.
Went back to school.
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
Nikie Salas
Phone
7084394495
Address
indian
Relationship
nurse

Name
Augustina Kuku
Phone
9176185182
Address
desplains
Relationship
nurse

Name
Phone
Address
Relationship
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

i hope you will consider my application. Also speak Japanese language. i'm a very reliable person love my job, very puntual, compansinate, and friendly. Thanks.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
Went back to school.
Additional Certifications
No additional certifications or licenses provided.

Have any of your certifications or licenses been suspended or revoked?  
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
olaide nduka-nwajei

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
November 13, 2019
This application has been submitted and can no longer be edited.