Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Desiree Danette Hall
Created: 11/13/2019
Other names under which employment may be verified:  none
Updated: November 13, 2019

Home Address
Street Address
8643 South Komensky Ave
Unit/Suite Number
8643 South Komensky Ave
City ST/Zip
Chicago, IL 60652
Home Phone
773-424-0927
Mobile Phone
708-305-2788
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? indeed
Rate of pay desired.   13.50
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
No
Dogs
No
Smoker
No
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  No
If yes, explain.  Dawson Tech Insituite- nursing assistant work in nursing home 3 years

How many years have you worked as a professional caregiver?  3
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.

team player watch patient carefully make sure everything in written down, report any changes to family and my job and family/patient doctor

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

taking care of patient in nursing home, patient said that she did not receive a tray, patient complain to the nurse, I wrote down what patient receive trays and who did not, after I show the nurse and doctor, they asked patient did she receive a tray, patient finally said yes, she was just hungry and wanted more food to eat, since then they always order extra for this patient since she had a good appetite, no hard feeling told patient I understand, just tell staff what you need and we will try to assist you, patient said Thank You. The patient and I and her family are good friends.

Availability

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

Education

High School   Paul Roberson
Location:   Chicago. IL
Did you graduate?   Yes
Subjects Studied   General

College   Kennedy King College
Location:   Chicago
Did you graduate?   Yes
Degree:   Liberal Arts

Other:   Dawson Tech Inst
Location:   Chicago
Did you graduate?    Yes
Degree:   Certificate

Special awards you earned or courses you have taken.
none

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Davita Mount Greenwood
Phone
773-445-0558
Address

3401 West 111 Street, Chicago IL 60655

Supervisor
Sonal Patel
Job Title
Patient Care Tech
Salary or Rate of Pay
19.75
Responsibilities
monitor patient blood pressure/blood flow/ check treatment water for patient on dialysis machine
From
08/09/2004
To
06/30/2017
Reason for Leaving
family issue mother was sick
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.
unemployed for 2 years and 3 months
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
Tammy Poma
Phone
773-834-4173
Address
5600 South Maryland
Relationship
co-worker

Name
Danielle Jones
Phone
773-445-0558
Address
3401 West 111 Street
Relationship
co-worker

Name
LaVonda McKissack
Phone
312-391-3634
Address
7923 South California
Relationship
co-worker
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

My name is Desiree Danette Hall, worked in the medical field for a long time, love working with the public and/ patient and their families, l get a chance to work closely with family/ patient so that the patient love one is comfortable with me taking care of patient.

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
unemployed for 2 years and 3 months
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)
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
Desiree Danette Hall

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
November 14, 2019
This application has been submitted and can no longer be edited.