Information Mm

Caritas Family Solutions

LaTanya Walker's Employment Application

Date Submitted: 8/22/2017

Job Title: Direct Support Professional -- CILA Homes Job Location: Caseyville

Personal Information

First Name: LaTanya

Last Name: Walker

Email: **********@*****.***

General Information

Current Address

Address: 1302 Robin st

Address #2: n/a

City: Venice

State: IL

Zip/Postal Code: 62090

Country: United States

Contact Information

Cell Phone: 618-***-****

Home Phone: 618-***-****

General Information

Have you ever worked for Caritas Family Solutions, Christian Social Services of Illinois or Catholic Social Services: No

If yes, please give date(s) and position: n/a

How did you hear about this positions (please specific if Advertisement or Employee Referral): employee referral ciearra pickett

Are you 18 years of age or older? Yes

Are you applying for: Full Time, Part Time, PRN (As needed) How many hours per week? 40

Indicate Day and Hours of Availability: mon thru sun Available Start Date: 8/23/2017

Are you related to anyone currently working for Caritas Family Solutions? No If yes, please provide name: n/a

Employment History

Please list ALL present and past employment for the past 10 years, beginning with the most recent. Also, list any experience similar to the position for which you are applying.: Current or Most Recent Employer:

Are you currently employed? Yes

Company Name: doors

Address: 1013 3rd street

Title: home care provider

From (MM/YY): 01-16

To (MM/YY): 08-17

Type of Employment: Part Time

Reason for Leaving: Currently Employed

Explanation: current

Starting Salary: 10.13

Final Salary: 10.13

Direct Supervisor: rosie dale

Company Phone: 618-***-****

OK to contact? Yes

Responsibilities and Duties: cooking cleaning running errands bathing grooming 2nd Previous Employer:

Company Name: n/a

City and State: Venice

Title: n/a

From (MM/YY): n/a

To (MM/YY): n/a

Type of Employment: n/a

Reason for Leaving: n/a

Explanation: n/a

Starting Salary: n/a

Final Salary: n/a

Direct Supervisor: n/a

Company Phone: 618-***-****

OK to contact? n/a

Responsibilities and Duties: n/a

3rd Previous Employer:

Company Name: n/a

City and State: Venice

Title: n/a

From (MM/YY): n/a

To (MM/YY): n/a

Type of Employment: n/a

Reason for Leaving: n/a

Explanation: n/a

Rate of Pay: n/a

Direct Supervisor: n/a

Company Phone: 618-***-****

OK to contact? n/a

Responsibilities and Duties: n/a

4th Previous Employer:

Company Name: n/a

City and State: Venice

Title: n/a

From (MM/YY): n/a

To (MM/YY): n/a

Type of Employment: n/a

Reason for Leaving: n/a

Explanation: n/a

Rate of Pay: n/a

Direct Supervisor: n/a

Company Phone: 618-***-****

OK to contact? n/a

Responsibilities and Duties: n/a

Education/Training

High School:

School Name: Madison high school

City and State: Venice

Last Grade Completed: 12

Graduate or GED? Yes

College or University:

Name of College/University: n/a

City and State: Venice

Course or Major: n/a

Years Completed: n/a

Degree: n/a

Graduate? n/a

Graduate School:

Name of College/University: n/a

City and State: Venice

Years Completed: n/a

Degree: n/a

Graduate? n/a

Other:

Name of School: Madison high school

City and State: Venice

Course or Major: n/a

Years Completed: n/a

Degree: n/a

Credit Hours Completed: n/a

Graduate? n/a

Driving Information (for positions requiring the use of a vehicles) Do you posses a valid driver's license? Yes

If yes - Issuing state: Illinois

Will you release Caritas Family SOlutions from liability regarding information obtained in reference to your driving record? Yes

If no, please explain: n/a

Special Skills

Computer Skills: n/a

If Typing, WPM: n/a

Other software or skills: n/a

Additional Skills: n/a

Experience (volunteering / Internships / Family): n/a References

Please list three professional references:

Reference Name: marquita lewis

Company: caritas family solution

Relationship: friend

Phone: 618-***-****

Email: *************@*****.***

Years Known: 25

Reference Name: ciearra pickett

Company: caritas family solution

Relationship: friend

Phone: 618-***-****

Email: ************@*****.***

Years Known: 25

Reference Name: markesha wright

Company: dealer

Relationship: cousin

Phone: 618-***-****

Email: **********@*****.***

Years Known: 30

Applicant's Statement

I certify and acknowledge that I have read and understood the questions on this form and the information sought. I further certify that my application contains no misrepresentations or falsifications and that the information I’ve given is true and complete to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentation may result in rejection of my application or discharge at any time before or after my employment begins. I authorize Caritas Family Solutions, its employees and agents, or other persons, schools, companies, law enforcement agencies, and their employees and agents, to provide or verify all of the information I have provided orally or in writing through methods of investigating, obtaining, compiling, examining, copying, or receiving records pertaining to my employment history. I hold harmless any individual, partnership, corporation, educational institution, or agency, its officers, agents and employees, including past and current employers, and Caritas Family Solutions from any liability for any damage whatsoever for issuing information used for the purpose of determining my employment eligibility.: I further agree to provide, at no expense to Caritas Family Solutions, the original of my high school, college, graduate school transcripts, or professional license or certificate to copy. I authorize the Agency to obtain checks of criminal records and driving records. I understand that Caritas Family Solutions will also obtain abuse and neglect records, and that my initial employment at Caritas Family Solutions as well as continued employment will be contingent upon cooperating in these checks and screenings and the information obtained will not necessarily reflect adversely upon my eligibility for employment. I understand that the screening checks will continue periodically.: I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this agency is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by the Executive Director. I understand that Caritas Family Solutions provides equal employment opportunities to all persons without regard to race, color, religion, disability, gender, age, sexual orientation or national origin, and promotes the full realization of this policy through a positive, continuing program of affirmative action. The agency is committed to equal opportunity for all applicants and employees in personnel matters including recruitment and hiring, benefits, training, promotion, compensation, transfer and layoff or termination.: JOB ACCOMMODATION At any time during the selection process, if you feel a job accommodation decision may be necessary, please advise your Human Resources Department representative.: I have read and agree to this disclaimer: Yes

Applicant Signature: latanya walker

Date: 8-22-2017

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