Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Kimberly Shorter
Created: 12/01/2019
Other names under which employment may be verified:  
Updated: December 1, 2019

Home Address
Street Address
8238 S Burley Ave
Unit/Suite Number
City ST/Zip
Chicago, IL 60617
Home Phone
17732436929
Mobile Phone
Alternate Phone
Email Address

Have you ever worked for us before?   No
If no, how did you hear about us?
Rate of pay desired.   14.25
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
Yes
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  No
If yes, explain.  

How many years have you worked as a professional caregiver?  0
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 love working with people, im a self starter,quick leaner,

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

I work in a mental health care facility where I learned a lot about how to deal with people who are dealing with their own issues. And it was a wonderful teaching experience for me someone who was looking forward to going to school to become a nurse.

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   Dwight D Eisenhower
Location:   Blue Island
Did you graduate?   Yes
Subjects Studied   General

College   Robert Morris university
Location:   Chicago, il
Did you graduate?   No
Degree:   Medical Assistant program

Other:   
Location:   
Did you graduate?   
Degree:   

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
Rainbow Beach Care Center
Phone
773-731-7300
Address

7325 S Exchange Ave, Chicago, IL 60649

Supervisor
Marvin chestnut
Job Title
Housekeeper
Salary or Rate of Pay
10.25
Responsibilities
Responsible for cleaning disinfecting and upkeep of all corridors resident rooms nursing stations casework offices
From
08/01/2009
To
09/14/2010
Reason for Leaving
Not Available
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.
All other emplyment was retail oriented
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
Latanya Williams
Phone
17738926534
Address
N/A
Relationship
Co worker( Rainbow beach care center)

Name
ADRIENNA THOMAS
Phone
7085433348
Address
N/a
Relationship
Fellow student

Name
Phone
Address
Relationship
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.
All other emplyment was retail oriented
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
Kimberly Shorter

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
December 1, 2019
This application has been submitted and can no longer be edited.