ROP APPLICATION

Directions: Please Print Legibly

Cortes
Omar
Name: __________________________________________

(Last)

(First)

April 27, 2015

____________________

(Middle)

Date

1414 W 1st St.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95341
_______________________________________________________________________________

(City)

(State)

(209 ) 261-4259

(Zip Code)

ocortes006@gmail.com
383-5360
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

Urgent Care Nurse
Skills and/or competencies which qualify you for this position:
Good worker under Pressure. Very confident and percise. Quick to respond and very active on the job.

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

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

_______________________
F7894532
(Number)

RECORD OF EDUCATION

Name of School
High School

City/State

Merced High
School

Course of
study or
major

Merced, CA

College/
University

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Yes

High
School

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Mens Soccer for 2 years.

FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

WEDNESDAY

PART TIME

THURSDAY

FRIDAY

SATURDAY

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

400
Farm Labor
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Planting, Cloning, Cleaning, Organizing

_________________________________________________

To:

April 2015
______

April 2015
______

Mo / Yr

Mo/Yr

1
0
Total ____Yrs.
________Mo.
9
Hours Per Week:_________
Reason For Leaving:
To further my education in
school.

From:

_________________________________________________
Supervisors Name:
Salvador Gonzalez
_____________________________________________________

_________________________________________________

3k
Title__________________________Last
Salary: _____________
Farm Labor

_________________________________________________

Duties:

_________________________________________________

Fruit Picking, Cleaning, Ladder Climbing, Tractor

driver.

_________________________________________________

To:

June 214
______

August 2014
______

Mo/ Yr

Mo/Yr

3
0
Total ____Yrs.
________Mo.
Hours Per Week:_________
10
Reason For Leaving:

Classes were interfering

with my schedule.

From:

Salinas Farm & Labor

Salinas Farm & Labor

_________________________________________________
_________________________________________________
Supervisors Name:
Sicario Gomez
________________________________________________

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.

Mario Boyzo

Complete Address (Include City, State, Zip)

234 W 2nd Merced, CA 95341

Phone

Occupation_______

(209)265-9087
Student

________________________________________________________________________________________________________________________________
2. Beto

Guzman

5643 Junpier Ave Atwater, CA 95341

(209) 564-7656
Forklift Driver

________________________________________________________________________________________________________________________________
3. Victor

Gomez

4532 Belize Ct Merced, CA 95341

(209) 756-6756
Student

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________