Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Rosalie Mosquera Donato
Created: 11/29/2019
Other names under which employment may be verified:  
Updated: December 19, 2019

Home Address
Street Address
8701 Wedgewood Drive
Unit/Suite Number
City ST/Zip
Burr Ridge, IL 60527
Home Phone
7738147108
Mobile Phone
7738147108
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   Negotiable
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
No
Dogs
Yes
Smoker
No
What languages do you speak?   english, spanish, tagalog
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Divine Providence In-Home Care Services, Inc. & Divine Providence Home Health Agency, Inc.

How many years have you worked as a professional caregiver?  20
What percent of your previous case work has been for an agency?  100
Please explain how you will contribute to strengthen the Water Tower Nursing team.

I am a licensed RN and have served many patients in a home health setting over the past 20 years.

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

I have helped my patients with medication management, nursing teachings, and show them how to prevent falls.

Availability

Days   Yes
Nights   Yes
Weekdays   Yes
Weekends   Yes
Live-in   Yes
Can you travel outside the city of Chicago to work?   Yes

Education

High School   
Location:   Philippines
Did you graduate?   Yes
Subjects Studied   

College   Central Philippine Universtiy
Location:   Philippines
Did you graduate?   
Degree:   B.S.N.

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
RLC Home Health Services
Phone
(773) 769-8100
Address

5757 N Lincoln Ave
Chicago, IL 60659

Supervisor
Job Title
Director of Nursing
Salary or Rate of Pay
Responsibilities
Supervises all operations, nursing services, and conducts monthly in services.
From
01/01/2005
To
11/30/2005
Reason for Leaving
May we contact this employer?  Yes

Company Name
Life Plus Home Health
Phone
(773) 907-9815
Address

2714 W Peterson Ave
Chicago, IL 60659

Supervisor
Nancy
Job Title
Director of Clinical Services
Salary or Rate of Pay
Responsibilities
Directed field staff Registered Nurses, Physical Therapists, Occupational Therapists, Speech Pathologists, Home Health Aides, and Licensed Clinical Social Workers in providing bedside care, treatment and clinical documentation for patients on cardiac, oncology and medical-surgical patients at their home. Directed RN field staff in handling the medication, administration, dressing changes, IVs and all other aspects of nursing care. Facilitated admissions, discharges, and transfers; prepared chart notes and other documentation; and spearhead on interdisciplinary team conferences and training programs.
From
12/05/2005
To
12/31/2006
Reason for Leaving
Left to start my own company.
May we contact this employer?  Yes

Company Name
Divine Providence Home Health Agency, Inc.
Phone
(773) 433-3320
Address

3550 W. Peterson Avenue, Suite 304
Chicago, IL 60659

Supervisor
Arnold Donato
Job Title
Director of Nursing/Administrator/President
Salary or Rate of Pay
Responsibilities
Key Accomplishments:  Achieved Home Care elite status for three consecutive years: 2007, 2008, & 2009 recognizing Divine Providence Home Health Services Inc. as agency in the top 25% of best providers of home health services in the United States.  Administrator of 120 employees which include 100 clinicians and 20 administrative staff  Helped refine unit policies and procedures in the areas of preventative health care practices, safety methods, discharge planning and documentation.  Responded to numerous volatile situations, earning the respect of physicians and coworkers for calm, levelheaded and quick thinking to restore the safety and security of patients and staff.  Completed training in team building, wound care & management and best home health practice administration. Clinical Nurse Consultant 2019 to Present Simply Home Health, Chicago, IL USA Provides clinical field training to newly hired nurse clinicians & Home Health Aides for Home Health Services. Provide in-service training for clinicians in Home Health. Provides consultation/nursing intervention patient/family in Home Health setting. Director of Nursing/Administrator/President 2006 to 2019 Divine Providence Home Health Services Inc, Chicago, IL USA Served as Director of Nursing & Administrator at home health agency for approximately 430 patients. Directs all clinical operations and administration. Actively participated in development and implementation of individual treatment plans for patients with broad range of medical problems. Ensured that doctors’ orders were effectively carried out by clinical staff, including testing, and medical procedures. Developed policies and procedures tailored to the need of the organization. Developed strategies in dealing with the ongoing health issues of patients based on OBQI report.
From
12/01/2006
To
09/09/2019
Reason for Leaving
Company closed.
May we contact this employer?  Yes

Company Name
Simply Home Health
Phone
(773) 306-5668
Address

6316 N Lincoln Avenue, Unit 2
Chicago, IL 60659

Supervisor
Evan Tubillara
Job Title
Nursing Consultant
Salary or Rate of Pay
Responsibilities
Provides clinical field training to newly hired nurse clinicians & Home Health Aides for Home Health Services. Provide in-service training for clinicians in Home Health. Provides consultation/nursing intervention patient/family in Home Health setting.
From
12/06/2019
To
12/11/2019
Reason for Leaving
Currently working there.
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
Menchu Dullas
Phone
(847) 208-8444
Address
6316 N. LINCOLN AVENUE, UNIT 2
Relationship
Director of Nursing

Name
Evan Tubillara
Phone
(773) 259-8228
Address
6316 N. LINCOLN AVENUE, UNIT 2
Relationship
Administrator

Name
Arnold J Donato
Phone
17738916279
Address
3550 W. Peterson Ave, #304, Chicago, IL
Relationship
Administrator
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)
If hired, would you be able to provide a copy of your Social Security Card?* (IDPH requirement)
No

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
Rosalie Donato

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
December 12, 2019
This application has been submitted and can no longer be edited.