Reset Form

Print Form

ROP APPLICATION
Directions: Please Print Legibly
Arroyo
Gisselle
Name: __________________________________________

(Last)

(First)

04-28-16
____________________

(Middle)

Date

2589 stonybrook ave

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

C.A
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 489-1641

(Zip Code)

gissellearroyo@yahoo.com
722-6744
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

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

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

City/State

Course of
study or
major

Merced high school

Merced/CA

general

College/
University

Merced college

Merced/CA

Nursing

Other
(Specify)

n/a

n/a

n/a

High School

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

Pending/20 diploma
16

n/a

n/a

n/a

n/a

List appropriate extracurricular activities, clubs, organizations and courses for this position:

FULL TIME

AVAILABILITY
SUNDAY

after 11a.m

MONDAY

after 4p.m

TUESDAY

after 4p.m

WEDNESDAY

after 4p.m

THURSDAY

after 4p.m

FRIDAY

after 4p.m

PART TIME

SATURDAY

after 11p.m

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
Emergency room aide
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Stocking rooms, shadowing nurses, work with

patience, vital signs, update boards, EKG

_________________________________________________

To:

2/16
______

current
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

6
Hours Per Week:_________
Reason For Leaving:
n/a

From:

333 Mercy Ave.

currently
______

Mo/ Yr

Mo/Yr

3
1
Total ____Yrs.
________Mo.
Hours Per Week:_________
30
Reason For Leaving:

n/a

Merced, CA 95340
(209)564-500

_________________________________________________
Supervisors Name:
Vincent Arroyo, RN
_____________________________________________________

_________________________________________________

volunteer
Title__________________________Last
Salary: _____________
Baby sitter

_________________________________________________

Duties:

_________________________________________________

Supervised newborn-1 year old

Prepared bottles/cooked breakfast, snacks, lunch
Coordinated nap time/baths
House cleaning

_________________________________________________

To:

1-20-15
______

Mercy Medical Center

Yazmin Escalante

2589 stonybrook ave

Merced, CA 95348
(910)818-0102

_________________________________________________
_________________________________________________

Supervisors Name:
Yazmin Escalante
________________________________________________
From:

To:

1-1-16
______

currently
______

Mo /Yr

Mo/Yr

0
3
Total ____Yrs.
________Mo.

1
Hours Per Week:_________
Reason For Leaving:

Merced high school

volunteer
Teachers Assistant
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Computer work, correct papers, filing papers,

making copies, supervising class in her absence

_________________________________________________

205 W. Olive Ave.

Merced, CA 95348
(209)385-6465

_________________________________________________

Supervisors Name:
Lorena ALvarez
________________________________________________

_________________________________________________

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

Name
1.

Jerry Fragasso

Complete Address (Include City, State, Zip)

2121E. Childs Ave. Merced, CA 95340

Phone

(559)917-8148

Occupation_______

ROP Instructor

________________________________________________________________________________________________________________________________
2. Alex

Muro

205 W. Olive Ave. Merced, CA 95348

(209)385-6465
Atendence Liaison

________________________________________________________________________________________________________________________________
3.

James Holland

205 W. Olive Ave. Merced, CA 95348

(209)385-6465

Social Science

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________
04-12-16
Gisselle Arroyo

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

Revised 7/10