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ROP APPLICATION
Directions: Please Print Legibly

Name: __________________________________________
Centeno Alyssa N. ____________________
March 21, 2018
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

5 Oakhurst Ct.
(P.O. Box or Street Number)

Merced CA 95340
_______________________________________________________________________________
(City) (State) (Zip Code)

( 209 ) 777-5747 ( )____________________ ____________________________

acenteno0400@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Radiology Technician Aide

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

CPR/first aid, knowledge of vital signs, medical terminology, blood borne pathogens training, HIPAA
training, OSHA training, patient transfers, gait training, MS Word, Excel, and medical office skills including
scheduling, phone etiquette, translating, etc.

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 Driver’s License?

‰ No ‰ Yes
✔ _______________________
Y4353379
(Number)

RECORD OF EDUCATION
Course of
study or Last year Did you Diploma
Name of School City/State major completed graduate? or degree
High School 1 2 3✔ 4 general
Merced High School Merced, CA general Pending
June 2018
College/ 1 2 3 4
University Merced College Merced, CA n/a n/a

Other
1 2 3 4
(Specify) n/a n/a n/a n/a n/a

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

Varsity Soccer. Courses: ROP Medical Technologies, Chemistry, Health and Family Living, Anatomy and
Physiology, Spanish, Biology

FULL TIME
AVAILABILITY ✔ PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

10:00a-6:00p after 3:00p after 3:00p n/a after 3:00p after 3:00p 1:00p-7:00p
RECORD OF EMPLOYMENT: (Begin with your most recent job)

Period of Employment Job Title and Duties Performed Company Name, Address, and Phone Number
From: To:
Radiology Technician Aide Salary: _____________
Title__________________________Last ROP Student Mercy Medical Center, Radiology
_________________________________________________
01/18
______ current
______
Mo / Yr Mo/Yr
Duties
333 Mercy Ave.
_________________________________________________
0
Total ____Yrs. 3
________Mo.
Vital signs, filing, patient histories, patient transfers, Merced, CA 95340
_________________________________________________
6
Hours Per Week:_________ patient education, scheduling patients
Reason For Leaving: (209) 564-5400
_________________________________________________
n/a
Supervisor’s Name: _________________________________________________
Kathy Monson
_____________________________________________________

From: To:
Various Alex Gonzalez
Intramural Soccer Program Salary: _____________
Title__________________________Last _________________________________________________
06/16
______ 08/16
______
Mo/ Yr Mo/Yr Duties:
n/a
_________________________________________________
0
Total ____Yrs. 2
________Mo. n/a
Soccer coach for kids 6-10 years old _________________________________________________
6
Hours Per Week:_________ n/a
_________________________________________________
Reason For Leaving:
(209) 812-5885
_________________________________________________
school
Supervisor’s Name:
Alex Gonzalez
________________________________________________

From: To:
Babysitting
Title___________________________Last various
Salary: ____________
Gabriel Saldivar
_________________________________________________
06/17
______ current
______
Mo /Yr Mo/Yr Duties:
n/a
_________________________________________________
1
Total ____Yrs. 7
________Mo. Cleaning up after a two year old, feeding her, and n/a
_________________________________________________
various
Hours Per Week:_________ bathing her. Going over numbers, colors, and letters (209) 761-9899
Reason For Leaving: with her. _________________________________________________

n/a _________________________________________________
Supervisor’s Name:
Gabriel Saldivar
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Jerry Fragasso 2121 E. Childs Ave.
(559) 917-8148
ROP Instructor
Merced, CA 95341
________________________________________________________________________________________________________________________________

2. James Holland 205 W. Olive Ave. (209) 325-1000

Teacher
Merced, CA 95348
________________________________________________________________________________________________________________________________

3. 2121 W. Olive Ave. (209) 325-1000

Allison Jones-Norton
Teacher
Merced, CA 95348
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

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