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ROP APPLICATION
Directions: Please Print Legibly
Ramos
Emma
Luna
Name: __________________________________________

(Last)

(First)

April 30, 2015

____________________

(Middle)

Date

1169 Loughborough Dr. Apt 5

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95348
Merced
_______________________________________________________________________________

(City)

( 209 ) 355-5841

(State)

(Telephone Number)

(Zip Code)

lunaemma10@yahoo.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Nursing Aide
Position applied for:_______________________________________________________________

Skills and/or competencies which qualify you for this position:

Certified in CPR, BLS, have completed training in Blood Borne Pathogens, Vital Signs, friendly, patient,
open-minded, hard working, great communication skills, and excellent with children.

Languages spoken and/or written (other than English):___________________________________

Spanish
Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?
No

Yes

If yes, explain:________________________________

Do you possess a valid California Drivers License?

No

Yes

_______________________
(Number)

RECORD OF EDUCATION

Name of School
High School

City/State

Merced High School

Course of
study or
major

Merced, CA

College/
University

General

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

Pending
June 2015

General

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
ROP Medical Occupation, Biology, Chemistry, Physics, Spanish 2 and 3 Honors, Geometry, Algebra 2, Pacific
Club(Special Need Students) and Babysitting.
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

open

8am- 10am

8am- 10am

8am- 10am

8am- 10am

8am- 10am

open

RECORD OF EMPLOYMENT: (Begin with your most recent job)

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Volunteer
Nursing Aide
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Clean exam rooms, take patients vitals, write in

patients files, and shadow doctors.

_________________________________________________

To:

Feb/14
______

May/14
______

Mo / Yr

Mo/Yr

0
4
Total ____Yrs.
________Mo.

4.5
Hours Per Week:_________
Reason For Leaving:
Graduation

From:

Kids Care

1260 North D Street

Merced, CA 95348
(209) 564-4500

_________________________________________________
Supervisors Name:
Mary Silva
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

Title___________________________Last Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

REFERENCES: Give the names of three persons not related to you.

Name
1.

Jerry Fragasso

Complete Address (Include City, State, Zip)

2121 E. Childs Ave.

Phone

(559) 917-8148

Occupation_______

ROP Instructor

Merced, CA 95340

________________________________________________________________________________________________________________________________
2. Dawn

Garrett

205 West Olive Ave.

(209 385-6467
English Instructor

Merced, CA 95348

________________________________________________________________________________________________________________________________
3.

Dolores Espinosa

205 West Olive Ave.

(209) 385-6465

Merced, CA 95348

Counselor

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts is cause for dismissal.

Date:_________________________Signature:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf

Revised 7/10