Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Shari Riaz Dumangcas
Created: 11/29/2019
Other names under which employment may be verified:  Shara
Updated: January 17, 2020

Home Address
Street Address
1628 West Fargo Ave. Apt. 2M Chicago, IL 60626
Unit/Suite Number
City ST/Zip
Chicago, IL 60626
Home Phone
7736001326
Mobile Phone
7736001326
Alternate Phone
7736001326

Have you ever worked for us before?   No
If no, how did you hear about us? Panopio estanislao Rivera
Rate of pay desired.   $15
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
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  C.N.A.

How many years have you worked as a professional caregiver?  15
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 will contribute to strengthening the Water Tower nursing team, by giving my best efforts to my clients, as well as my co-workers. I will keep a positive attitude towards my workspace.

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

I love what I'm doing as a caregiver, one of my clients at the hallmark facility, but she's gone because she had cancer. She's so strict, but I liker her and her family are nice. I was the one to bring her to the hospital and stay with her, and until the doctor said she's gong home, and that her days are counting. I did my job as a CNA at that time cause she's bedridden, and she's gone.

Availability

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

Education

High School   Notre Dame of Lambayong
Location:   Tacurong city 9802
Did you graduate?   Yes
Subjects Studied   Algebra, Biology, English, Modern World, Writing workshop

College   San Pedro College of Davao City
Location:   Manila, Philippines
Did you graduate?   No
Degree:   Undergraduate

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
Private Client
Phone
331-777-2969
Address

1350 Westmoor trail winnetka, IL 60093-1637

Supervisor
Carole Levy
Job Title
Caregiver
Salary or Rate of Pay
$20 hourly
Responsibilities
Caregiver
From
10/28/2019
To
11/10/2019
Reason for Leaving
Cover up for rehab, for a week.
May we contact this employer?  Yes

Company Name
Private Client
Phone
224-374-5850
Address

205 Lakeside PL. Highland park, IL, 60035-5318

Supervisor
Michael A. Stein, Son
Job Title
Caregiver
Salary or Rate of Pay
$20 hourly
Responsibilities
Caregiver
From
07/01/2019
To
10/13/2019
Reason for Leaving
The client recovered from cancer. she doesn't need a caregiver anymore.
May we contact this employer?  Yes

Company Name
Private Client
Phone
312-371-7253
Address

Brookdale Lake Shore Drive
2960 N Lake Shore Dr, Chicago, IL

Supervisor
Charles Taylor
Job Title
Caregiver
Salary or Rate of Pay
$200 12 hours
Responsibilities
Caregiver
From
06/01/2017
To
10/02/2018
Reason for Leaving
Client died due to cancer.
May we contact this employer?  Yes

Company Name
Home for good senior care
Phone
773-572-4875 or 773-971-1437
Address

6246 N Pulaski Rd, chicago, IL 60646

Supervisor
Cecil
Job Title
Caregiver
Salary or Rate of Pay
$13
Responsibilities
Caregiver
From
02/01/2018
To
03/01/2018
Reason for Leaving
The client died of cancer, in rehab
May we contact this employer?  Yes

Company Name
By your side agency
Phone
708-476-6036
Address

28 E Hinsdale Ave, Hinsdale, IL, 60521

Supervisor
Juliat
Job Title
Caregiver
Salary or Rate of Pay
$13
Responsibilities
Caregiver
From
01/01/2017
To
01/01/2018
Reason for Leaving
The client passed away because of cancer
May we contact this employer?  Yes

Company Name
Care Advocates of Illinois
Phone
3127303080
Address

5940 W. Touhy Ave
190 Niles, Illinois 60714
United States

Supervisor
Shena
Job Title
Caregiver
Salary or Rate of Pay
14
Responsibilities
Caregiver
From
01/01/2016
To
06/17/2017
Reason for Leaving
Gone
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
Care Advocate of Illinois
Phone
3127303080
Address
5940 W. Touhy Ave. Ste. 190 Niles, Illinois 60714 Unites States
Relationship
agency

Name
Charles Taylor
Phone
3123717253
Address
1528 W. Adams Street Chicago, Illinois 60607 Unites States
Relationship
Client Family

Name
Home for good senior care Inc.
Phone
7735724875
Address
6246 N. Pulaski road Chicago, Illinois 60646 United states
Relationship
Agency
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)
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
Shara Riaz Dumangcas

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
January 14, 2020
This application has been submitted and can no longer be edited.