ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Miao Jia yi ____________________
May 9, 2019
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

393 Buena Vista Court
(P.O. Box or Street Number)

Merced CA 95348
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 761-8857 ( )____________________ ____________________________

Jmiao105321@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Registered Nurse

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

Speaks more than one language: Cantonese, Mandarin, and little Spanish. Adaptability, Organizarion, Time
Management, Planning and Research, Relevant Work Experience, Responisiblity, Respectful, flexibility.

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

Cantonese, Mandarin, and 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 _______________________
Y3980685
(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 Merced High School Merced Nursing 1 2 3 4 Yes Yes

College/ 1 2 3 4
CSU Stanislaus Turlock Nursing No No
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Leo Club, Suicide Prevention Club, Culinary Club, Documentary Club, Associate Pre-Medical Students Club,
Mercy Volunteer Program, Gateway Scholars Program. English 01A, Guidance 30, Elementary Statistics

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

No Yes Yes Yes Yes Yes No

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:
Asian Cafe
Title__________________________Last $640-800
Salary: _____________
North Golden State Boulevard, Turlock, CA 9538
_________________________________________________
1/19
______ ______
Mo / Yr Mo/Yr
Duties
(209) 632-0451
_________________________________________________
5
Total ____Yrs. ________Mo.
Waitress, Work only weekends _________________________________________________
9
Hours Per Week:_________
Reason For Leaving: _________________________________________________

Supervisor’s Name: _________________________________________________

_____________________________________________________

From: To:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo/ Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisor’s Name:
________________________________________________

From: To:
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisor’s Name:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Tan Bo North Golden State boulevard, Turlock, CA 95380 (209) 632-0451
Manager
________________________________________________________________________________________________________________________________

2.

________________________________________________________________________________________________________________________________

3.

________________________________________________________________________________________________________________________________

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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