Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Marivic Avila Robles
Created: 12/11/2019
Other names under which employment may be verified:   None
Updated: December 16, 2019

Home Address
Street Address
6933 north Kedzie ave apt. 514
Unit/Suite Number
City ST/Zip
Chicago, IL 60645
Home Phone
3125089040
Mobile Phone
3125089040
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Refer by a friend
Rate of pay desired.   $20
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
No
What languages do you speak?   english, tagalog
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?  19
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.

With my years of experience working as a caregiver I can proudly say I’m such a team player and my compassion in taking care of our elderly is not new to me because of my cultural values. I can honestly say being a team player and my devotion and being compassionate in what I you do is something I can contribute to strengthen the Water Tower nursing team.

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

Taking care of a lady for 6 years in a assisted living facility and way back 2002 to 2008 then the family decided to put my patient in a nursing home facility even though the facility is complete with all experience nurses and çna still the family decided to retain my job in taking care of their mother. For that I was so thankful and great full because they know how I value my work and how dedicated I was with their mom. The family kept me for another 6 years and during that period as if I’m a member of the family , they treat me like their own . And to cut it short still worked for another 8 years with them until she passed away 2014. She is my longest lady to date that I served.

Availability

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

Education

High School   College of immaculate Concepcion
Location:   Cabanatuan city Philippines
Did you graduate?   Yes
Subjects Studied   

College   Bachelor of science on Nursing
Location:   Cabanatuan city Philippibes
Did you graduate?   Yes
Degree:   Bachelor of Science in Nursing

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
Frank Alschuler
Phone
Address

W. Junior Terrace Chicago Illinois

Supervisor
Mimi Alschuler-708-9899668
Job Title
Caregiver
Salary or Rate of Pay
$18/hour
Responsibilities
Medication management , assistance with ADL , escort to MD appointment bathing , meal preparation , laundry and light housekeeping
From
11/01/2018
To
09/02/2019
Reason for Leaving
Client Expired
May we contact this employer?  Yes

Company Name
Robert White
Phone
Address

C/O Brookdale Senior Living
Lakeshore Drive Chicago Illinois

Supervisor
David White
Job Title
Caregiver
Salary or Rate of Pay
$15
Responsibilities
Medication management, assistance with ADL ,escort to MD appointment , bathing ,meal preparation and light housekeeping
From
09/01/2017
To
10/01/2018
Reason for Leaving
Client Expired
May we contact this employer?  Yes

Company Name
Shirley Rosenthal
Phone
Address

C/O The Breakers

Supervisor
Robert Rosenthal
Job Title
Caregiver
Salary or Rate of Pay
$240/day
Responsibilities
Medication management, assistance with ADL , escort to MD appointment, bathing , meal preparation and light housekeeping
From
04/01/2016
To
08/01/2017
Reason for Leaving
Client moved to Oregon
May we contact this employer?  Yes

Company Name
Marthy Kranitz
Phone
Address

330 Diversey Ave Chicago Illinois

Supervisor
Betsy Kranitz-773-5104371
Job Title
Caregiver
Salary or Rate of Pay
$18/hour
Responsibilities
Medication management, assistance with ADL , escort to MD appointment, bathing , meal preparation and light housekeeping
From
05/01/2015
To
07/01/2016
Reason for Leaving
Client Expired
May we contact this employer?  Yes

Company Name
Vivian Garland
Phone
Address

C/O The Breakers

Supervisor
Cynthia Goldring- 8477358055
Job Title
Caregiver
Salary or Rate of Pay
$10/hour
Responsibilities
Medication management, assistance with ADL , escort to MD appointment, bathing , meal preparation, laundry and light housekeeping
From
04/02/2002
To
04/01/2014
Reason for Leaving
Daughter cut the service
May we contact this employer?  Yes

Company Name
Mary Schlosberg
Phone
Address

C/O The Breakers

Supervisor
Job Title
Caregiver
Salary or Rate of Pay
130/day
Responsibilities
Medication management, Assistance with ADL, light housekeeping, Grocery shopping , escort to MD appointment, Bathing and Meal preparation
From
02/01/2000
To
03/01/2002
Reason for Leaving
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.
Vacation in between gaps
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
Jemima Reyes
Phone
847-3297691
Address
Relationship
Friend

Name
Luth De Leon
Phone
847-9127845
Address
Relationship
Friend

Name
Rusel Villalon
Phone
847-8778296
Address
Relationship
Friend
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

I’m looking forward to be a part of a well known Water Tower Nursing Home Care

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
Vacation in between gaps
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
Marivic A. Robles

PART FIVE – APPLICATION SUBMISSION

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