Caregiver Job Application


APPLICANT INFORMATION

Application Status
Submitted
Name (First, Middle, Last)
Elisa del Mar Manulat
Created: 12/17/2019
Other names under which employment may be verified:  
Updated: December 30, 2019

Home Address
Street Address
6033 N Sheridan Rd.
Unit/Suite Number
Apt 27H
City ST/Zip
Chicago, IL 60660
Home Phone
773-728-4818
Mobile Phone
732-372-3870
Alternate Phone

Have you ever worked for us before?   No
If no, how did you hear about us? Seen in Water Tower
Rate of pay desired.   $180 up
Do you have a valid driver’s license?   No
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
No
What languages do you speak?   
Do you have any caregiver training from other home services agencies?  
If yes, explain.  yes with custom homecare and homecare angels

How many years have you worked as a professional caregiver?  10
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 work as professional as I can and make a good impression on the clients

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

I've had experiences with Alzheimer,parkinsons,hospice,cancer,chronic kidney disease,diabetes.. and i have cared one client for 7 years and 3 months then she passed away.

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   i got a GED in Philippines
Location:   
Did you graduate?   Yes
Subjects Studied   

College   
Location:   
Did you graduate?   
Degree:   

Other:   
Location:   
Did you graduate?   
Degree:   

Special awards you earned or courses you have taken.
CNA

Military Service

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

Licenses and Certifications

EMPLOYMENT HISTORY

Company Name
alternative homecare ltd
Phone
630 971 0778
Address

634 n cass ave., westmont,illinois 60559

Supervisor
conchita
Job Title
caregiver
Salary or Rate of Pay
$150
Responsibilities
taking care of all the client's needs
From
05/01/2017
To
12/30/2019
Reason for Leaving
still with them
May we contact this employer?  Yes

Company Name
Angels Home Care
Phone
847-312-2777
Address

5135 Golf Rd. Ste. 200
Skokie, IL 60077

Supervisor
Al
Job Title
caregiver
Salary or Rate of Pay
$180 per day
Responsibilities
activities of daily living we normally do
From
07/01/2018
To
12/30/2019
Reason for Leaving
still with them
May we contact this employer?  Yes

Company Name
custom home care
Phone
773 561 4663
Address

2716 W Peterson Ave Chicago,IL 60659

Supervisor
shawn, becky
Job Title
caregiver
Salary or Rate of Pay
weekdays $169 - weekends $247 (live-in 24hrs)
Responsibilities
taking good care of clients, activities of daily living
From
06/04/2019
To
12/30/2019
Reason for Leaving
still with them
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.
yes,when im on vacation
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
theresa strnad
Phone
773 930 5646
Address
Relationship
friend

Name
bob loftus
Phone
630 553 5013
Address
11159 faxon rd yorlville,il 60560
Relationship
client's son

Name
tony d'orio
Phone
312 805 1123
Address
664 n.peoria #5v chicago,illinois 60642
Relationship
client's son
Additional Information
Feel free to add any notes or additional information to your application in the space provided below.

i will provide a recommendation letter from my previous work it all says in there

Thank you for entering your employment history. If gaps exist in your employment history, please explain the gaps here.
yes,when im on vacation
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
Elisa del Mar Manulat

PART FIVE – APPLICATION SUBMISSION

Application Status
Submitted
Date Submitted
December 30, 2019
This application has been submitted and can no longer be edited.