ROP APPLICATION

Directions: Please Print Legibly

Rodriguez
Yessica
Karina
Name: __________________________________________

(Last)

(First)

5/11/2015
____________________

(Middle)

Date

89 Emerald Drive
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95340
_______________________________________________________________________________

(City)

(209 ) 761-0445
(Telephone Number)

(State)

(Zip Code)

yessicakesrodriguez@yahoo.com
201-3407
( 559 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Nurse
Skills and/or competencies which qualify you for this position:
Hardworking, Persistent, Strong, Quick on my feet, Knowledgable, Kind

Spanish
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
High School

City/State

Merced High School

Course of
study or
major

Merced, CA

College/
University

General
Education

Last year
completed
1 2 3 4

Did you
graduate?
Yes

Diploma
or degree
Diploma

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Gay Straight Alliance (GSA), Future Homemakers of America (FHA), California Scholarship Federation (CSF),
Journalism Club (Secretary), Academic Mentor
FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

WEDNESDAY

PART TIME

THURSDAY

FRIDAY

SATURDAY

10 AM - 10 PM 10 AM - 10 PM 10 AM - 10 PM 10 AM - 10 PM 10 AM - 10 PM 10 AM - 10 PM 10 AM - 10 PM

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

$50/week
Babysitter
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Preparing meals for an 8 year old boy, making sure

he takes ADHD pills

_________________________________________________

To:

6/2013
______

8/2013
______

Mo / Yr

Mo/Yr

2
Total ____Yrs. ________Mo.
50
Hours Per Week:_________
Reason For Leaving:
School

From:

(559) 223-0950

_________________________________________________
Supervisors Name:
Linda Lewis
_____________________________________________________

_________________________________________________

$20/day
Title__________________________Last
Salary: _____________
Babysitter

_________________________________________________

Duties:

_________________________________________________

Looking after a 10 year old boy, cooking 3 meals a

day

_________________________________________________

To:

6/2014
______

9/2014
______

Mo/ Yr

Mo/Yr

3
Total ____Yrs. ________Mo.
Hours Per Week:_________
40
Reason For Leaving:

1275 N 12th Street, Chowchilla CA 93610

183 Lake Avenue, Merced, CA 95340

(209) 761-7412

_________________________________________________

School

_________________________________________________
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.

Anaise Jimenez

Complete Address (Include City, State, Zip)

57 E 22nd Street, Merced, CA, 95340

Phone

Occupation_______

(209) 628-8862
Child Development

________________________________________________________________________________________________________________________________
2. Brandi

Thomas

1275 N 12th Street, Chowchilla, CA, 93610

(559) 223-0950
Nurse

________________________________________________________________________________________________________________________________
3. Magdelena

Stamps

3769 Morning Dove Avenue, Merced, CA, 95340

(209) 230-2150
Nurse

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________