Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
MAUREEN Deko OKEGBE
Created: 06/04/2019
Other names under which employment may be verified:  
Updated: June 5, 2019

Home Address
Street Address
6148 N Hoyne ave, Apt 3N
Unit/Suite Number
City ST/Zip
Chicago, IL 60659
Home Phone
Mobile Phone
7738651179
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Internet
Rate of pay desired.   $14.00
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
Yes
Dogs
Yes
Smoker
Yes
What languages do you speak?   english
Do you have any caregiver training from other home services agencies?  Yes
If yes, explain.  Home instead senior care, right at home senior care; home care assistance senior care

How many years have you worked as a professional caregiver?  9
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.

I am a team player; very detailed oriented, dedicated, dependable, out going with a big heart and alot of empathy. I love working with elderly and am always happy to put a smile on their faces.

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

I had a client that always wait on me by the door every morning calling my name and singing just to usher me in and always happy to see me everyday.

Availability

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

Education

High School   Hillcreast high school
Location:   Benin Nigeria
Did you graduate?   No
Subjects Studied   Social studies

College   Ambrose Alli university Nigeria
Location:   Nigeria
Did you graduate?   
Degree:   Bachelor in Bussiness Administration

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
I can't work with any animals dogs or cats. Am avaliable to work overnight full time.i can work with smokers, hospice . I could'nt check yes to all these on the application.

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
Home instead senior care
Phone
8476731250
Address

8822 niles centre rd skokie

Supervisor
Sarah
Job Title
Care giver
Salary or Rate of Pay
$13.50
Responsibilities
Activities of daily living, companionship, light housekeeping, meal preparation, medication reminder
From
02/01/2016
To
06/04/2019
Reason for Leaving
Still working but looking to leave.
May we contact this employer?  No

Company Name
Right @home senior care
Phone
7737754667
Address

8424 Skokie Blvd,

Supervisor
Mellisa
Job Title
Care giver
Salary or Rate of Pay
$13.00
Responsibilities
Activities of daily living, companionship, light housekeeping, meal preparation, medication reminder
From
06/03/2015
To
06/04/2019
Reason for Leaving
Still working
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
Nana Maggie johnson
Phone
3124785219
Address
1413 N chase Ave, Chicago il
Relationship
Co worker

Name
Brenda carter
Phone
3123910521
Address
North Ave, Chicago il
Relationship
Co worker

Name
Doh adotey
Phone
7735677806
Address
1623 s Washtenaw Ave, Chicago il
Relationship
Friend
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
Maureen okegbe

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
June 5, 2019
This application has been submitted and can no longer be edited.