ROP APPLICATION

Directions: Please Print Legibly

Yang
Kristina
P
Name: __________________________________________

(Last)

(First)

27th Apirl 2015

____________________

(Middle)

Date

392 Hearst Drive

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95348
_______________________________________________________________________________

(City)

(209 ) 386-0157
(Telephone Number)

(State)

(Zip Code)

Kyang03@hotmail.com
355-5067
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Registered Nurse
Skills and/or competencies which qualify you for this position:
I am conscientious person who works hard and pays attention in detail. I'm flexible, quick to pick up on new
skills and eager to learn from others.

Hmong
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

_______________________
0000000000000
(Number)

RECORD OF EDUCATION

Name of School
High School

College/
University

City/State

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

Merced High School

Merced, CA

Nursing

1 2 3 4

Yes

Diploma

CSU Stanislaus

Merced, CA

Nursing

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Asian club: member
Leo club: member
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

Any time

Any time

Any time

Any time

Any time

Any time

Any time

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

-------Cashier
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Handling money
Supervising co-workers

_________________________________________________

To:

05/11
______

present
______

Mo / Yr

Mo/Yr

40
4
Total ____Yrs.
________Mo.
9-10
Hours Per Week:_________
Reason For Leaving:
Present

From:

Merced High Union High School

205 West Olive Ave, Merced, CA 95348

(209)355-0000

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

Title___________________________Last Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

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

Name
1.

Slyvia Garcia

Complete Address (Include City, State, Zip)

300 Hunter Drive, Merced, CA 95348

Phone

Occupation_______

(209) 560-9945
Supervisior

________________________________________________________________________________________________________________________________
2. Tony

Hurrea

893 Jewels Court, Merced, CA 95348

(209) 722-7690
Supervisor

________________________________________________________________________________________________________________________________
3. Stephan

Eccles

645 Walby Way, Merced, CA 95348

(209) 283-8246
Marine 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:_________________________________________________________________