ROP APPLICATION

Directions: Please Print Legibly

Yang
Sabrina
Name: __________________________________________

(Last)

(First)

April 28, 2016

____________________

(Middle)

Date

635 Seneca St
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95340
_______________________________________________________________________________

(City)

(State)

( 209 ) 355-8228

(Zip Code)

sabrinayang_07@yahoo.com
282-0754
( 599 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Nursing Aide
Position applied for:_______________________________________________________________

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

CPR/ First Aid, Vital Sign, Blood Borne Pathogen, HIPAA, Good listener, Helping others,

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

Hmong
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

Nursing

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
June 2016

Diploma

N/A

N/A

N/A

N/A

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Kiddieland, Farmer Market, Key Club, Thanksgiving Basket, Ocean clean-up, Valentine Dance,

FULL TIME

AVAILABILITY
SUNDAY

N/A

MONDAY

N/A

TUESDAY

3-5:30 p.m

WEDNESDAY

3-5:30 p.m

THURSDAY

3-5:30 p.m

FRIDAY

3-5:30 p.m

PART TIME

SATURDAY

N/A

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

Period of Employment
From:

Company Name, Address, and Phone Number

Volunteer
Nursing Aide
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Vital signs, filing, patient histories, patient transfers,

patient education, scheduling patients, etc.

_________________________________________________

To:

2016
______

current
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

5
Hours Per Week:_________
Reason For Leaving:

From:

Job Title and Duties Performed

333 Mercy Ave

current
______

Mo/ Yr

Mo/Yr

8
8
Total ____Yrs.
________Mo.
Hours Per Week:_________
24/7
Reason For Leaving:

Merced, CA 95340
209-564-5400

_________________________________________________
Supervisors Name:
Rachel Abril
_____________________________________________________

_________________________________________________

$0.00
Title__________________________Last
Salary: _____________
Babysitting

_________________________________________________

Duties:

_________________________________________________

Change diapers, cook, playing with children, help

with homework, 4, ages 1 through 8 years old.

_________________________________________________

To:

06/2007
______

Mercy Medical Center, 4th floor

Ya Yang

635 Seneca St.

Merced, CA 95340
209-654-9765

_________________________________________________
_________________________________________________
Supervisors Name:
Ya Yang
________________________________________________

From:

To:

2015
______

current
______

Mo /Yr

Mo/Yr

6
Total ____Yrs. ________Mo.

Key Club

Volunteer
Key Club
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Help out others, kiddieland, farmer market

_________________________________________________

205 W Olive Ave

1
Hours Per Week:_________
Reason For Leaving:

Merced, CA 95348
209-261-4427

_________________________________________________

Supervisors Name:
Secretary: Geffry Flores
________________________________________________

_________________________________________________

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 Medical Technologie

Merced, CA 95341

________________________________________________________________________________________________________________________________
2.

Andrea DeLeon

205 W. Olive Ave

209-777-2496
ELD/English 2

Merced, CA 95348

________________________________________________________________________________________________________________________________
3.

Tammie Meyer

205 W. Olive Ave

209-756-8901

Merced, CA 95348

Child Development/Health

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

4/18/2016
Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10