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ROP APPLICATION
Directions: Please Print Legibly
Yanez
Esmeralda
Name: __________________________________________

(Last)

(First)

3/4/16
____________________

(Middle)

Date

3257 Loughborough Dr.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 230-8731

(Zip Code)

esme66yanez@gmail.com
723-1352
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

Nurse Aide
Skills and/or competencies which qualify you for this position:
CPR/ First Aid, BLS, knowledge in medical terminology, Bloodborne Pathogens training, HIPAA training,
OSHA training. Bilingual (Fluent in Spanish).

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 Drivers License?

No

Yes

_______________________
F7564187

(Number)

RECORD OF EDUCATION

High School

College/
University
Other
(Specify)

Name of School

City/State

Course of
study or
major

Merced High School

Merced, Ca

General

Merced College. (Child

Development)

Merced, Ca

Nursing

n/a

n/a

n/a

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

Pending

General

n/a

n/a

n/a

n/a

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Dare-2-Care Club, Soccer Club, CSF, Link Crew, Club APS ( Association of Pre-Med Students)(officer), Kiwins,
Freshman Mentor. Courses: ROP Medical Technologies, Chemistry, Child Development, Physics.
FULL TIME

AVAILABILITY
SUNDAY

10am-4pm

MONDAY

4pm-8pm

TUESDAY

4pm-8pm

WEDNESDAY

5pm-8pm

THURSDAY

5pm-8pm

FRIDAY

6pm-9pm

PART TIME

SATURDAY

10 am-4pm

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Voluntary
Nursing aide
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Getting patients in and out of bed. Attending and

providing care to those in need.

_________________________________________________

To:

4/16
______

Current
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

Hours Per Week:_________
Reason For Leaving:

n/a

From:

333 Mercy Ave, Merced, CA 95340

Current
______

Mo/ Yr

Mo/Yr

2
1
Total ____Yrs.
________Mo.

(209)564-5000

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

$10/hr
Title__________________________Last
Salary: _____________
Waitress

_________________________________________________

Duties:

_________________________________________________

Cleaning, attending customers, restocking.

_________________________________________________

To:

12/14
______

Mercy Medical Center

Fiesta Mexicana

530 W 16th st. Merced, Ca 95348

Hours Per Week:_________

38
Reason For Leaving:

(209)722-2772

_________________________________________________
_________________________________________________

n/a
Supervisors Name:
Teresa Granados
________________________________________________
From:

To:

10/14
______

current
______

Mo /Yr

Mo/Yr

1
4
Total ____Yrs.
________Mo.

3
Hours Per Week:_________
Reason For Leaving:

n/a

voluntarily
Babysitting
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Being responsible for the care and health of my

niece.

_________________________________________________

3257 Loughborough Dr. Merced, Ca 95348

(209) 761-0816
Karina Lupian

_________________________________________________

Supervisors Name:
Karina Lupian
________________________________________________

_________________________________________________

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

Name
1.

Gerald Fragasso

Complete Address (Include City, State, Zip)

2121 E Childs Ave, Merced, CA 95341

Phone

(559) 917-8148

Occupation_______

Medical Technologies

________________________________________________________________________________________________________________________________
2. Alex

Muro

205 W Olive Ave, Merced, CA 95348

(209) 385-6454
Attendance Liaison

________________________________________________________________________________________________________________________________
3.

James Holland

205 W Olive Ave, Merced, CA 95348

(209) 761-9609

History Instructor

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

4/11/2016
Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10