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ROP APPLICATION
Directions: Please Print Legibly
Zarafael
B.
Name: Lintao
__________________________________________

(Last)

(First)

March 4, 2014
____________________

(Middle)

Date

3575 Sarasota Ave

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95348
_______________________________________________________________________________

(City)

(State)

(209 ) 723-5493

(Zip Code)

zahzahlintao@yahoo.com
233-5416
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Occupational therapist aide

Position applied for:_______________________________________________________________

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

BLS certified, knowledge of vital signs, medical terminology, basic pharmacology, blood born pathogens
training, HIPAA training, OSHA training, office skills, MS Word, phone etiquette, first aid training

Spanish, Tagalog
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

_______________________
(Number)

RECORD OF EDUCATION

Name of School

City/State

Course of
study or
major

High School

College/
University
Other
(Specify)

Merced High School

Merced, CA

general

n/a

n/a

n/a

n/a

n/a

n/a

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Pending
June 2013

general

n/a

n/a

n/a

n/a

1 2 3 4

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
KIWIN'S club, JAS club, volunteer for VSA, mentor, Tae Kwon Do 7 years. Courses: Medical ROP, Anatomy,
Biology, Health and Family Living, Child Development, Chemistry, AP English, Spanish1,2,3, CLAWS program
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

n/a

12pm-6pm

12pm-6pm

1pm-7pm

12pm-6pm

12pm-7pm

n/a

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Babysitter
volunteer
Title__________________________Last
Salary: _____________

Maryan
Alvarez
_________________________________________________

Duties

3533
Sarasota Ave
_________________________________________________

To:

12/13
______

current
______

Mo / Yr

Mo/Yr

3
Total 0
____Yrs. ________Mo.
5
Hours Per Week:_________
Reason For Leaving:

n/a

From:

Responsible for the health and safety of children

ages 7, 9, 14. Played with the younger ones and
helped 6 year old read

Merced,
CA, 95348
_________________________________________________

Supervisors Name:
Maryan Alvarez
_____________________________________________________

_________________________________________________

To:

1/14
______

current
______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

4
Hours Per Week:_________
Reason For Leaving:

(209)628-2132
_________________________________________________

volunteer
Title__________________________Last
Salary: _____________
OT aide

Rascal
Creek Physical Therapy
_________________________________________________

Duties:

3327
M St. Suite A
_________________________________________________

Print copies, help patients with routines when they

visit, ultrasound, infrared.

n/a

Merced,
CA, 95348
_________________________________________________

(209)
722-1030
_________________________________________________
_________________________________________________

Supervisors Name:
Michael Clark
________________________________________________
From:

To:

6/12
______

7/13
______

Mo /Yr

Mo/Yr

2
Total ____Yrs.
________Mo.

4
Hours Per Week:_________
Reason For Leaving:

volunteer
Helper
Title___________________________Last
Salary: ____________

VSA
_________________________________________________

Duties:

645
W. Main St.
_________________________________________________

Helped others with special needs with the activities

such as arts and craft, dancing, and playing with
music.

School
Supervisors Name:
John Russel
________________________________________________

Merced,
CA, 95343
_________________________________________________
(209)
388-1090
_________________________________________________
_________________________________________________

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

Name
1.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

3169 M St

Delpar Diolazo

Merced, CA 95349

(209)722-6231

R.N, B.S.N

________________________________________________________________________________________________________________________________

2121 E. Childs Ave

2.

(559)917-8148

Jerry Fragasso

ROP Instructor

Merced, CA, 95341

________________________________________________________________________________________________________________________________

205 W Olive Ave

3.

Tammy Meyer

(209)385-6565

Merced, CA, 95348

Teacher

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10