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ROP APPLICATION
Directions: Please Print Legibly
Arevalo
Christina
Salud
Name: __________________________________________

(Last)

(First)

March 4, 2016
____________________

(Middle)

Date

1251 Esplanade Dr
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209) 628-7034

(Telephone Number)

(Zip Code)

carevalo102886@gmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Nursing Aide
Position applied for:_______________________________________________________________

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

Bilingual in Spanish
Vital Signs
Certified in HIPAA, OSHA/Bloodborne Pathogens, CPR and First Aid

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

_______________________

(Number)

RECORD OF EDUCATION

Name of School

City/State

Course of
study or
major

Mered High School

Merced, CA

General

College/
University

Merced College

Merced, CA

Nursing

Other
(Specify)

n/a

n/a

n/a

High School

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

Pending
June 2016

General

n/a

n/a

n/a

n/a

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Academic Mentor Club-President
Dare2Care
FHA
Soccer Club

FULL TIME

AVAILABILITY
SUNDAY

Any

MONDAY

Any

TUESDAY

Any

WEDNESDAY

Any

THURSDAY

Any

FRIDAY

Any

PART TIME

SATURDAY

Any

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

Period of Employment
From:

Company Name, Address, and Phone Number

volunteer
Babysitting
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Provide care to children under the age of 12. Keep

the house organized and kept to the schedule the
parents would leave.

_________________________________________________

Supervisors Name:
Elizabeth Alarcon
_____________________________________________________

_________________________________________________

volunteer
Title__________________________Last
Salary: _____________
Office Assistant

_________________________________________________

Duties:

_________________________________________________

File papers, organize files, type work reports, use of

google excel,

_________________________________________________

To:

1/2015
______

current
______

Mo / Yr

Mo/Yr

1
1
Total ____Yrs.
________Mo.

8
Hours Per Week:_________
Reason For Leaving:
n/a

From:

Job Title and Duties Performed

1921 Belcher Ave

To:

2/2015
______

current
______

Mo/ Yr

Mo/Yr

1
1
Total ____Yrs.
________Mo.
Hours Per Week:_________
20
Reason For Leaving:

Elizabeth Alarcon

Merced, CA, 95348

(209)628-0539

_________________________________________________

Modular Technologies

1251 Esplanade Dr

Merced, CA, 95348

(209)600-8152

_________________________________________________
_________________________________________________

n/a
Supervisors Name:
Henry Arevalo
________________________________________________
From:

To:

8/2015
______

5/2016
______

Mo /Yr

Mo/Yr

0
10
Total ____Yrs.
________Mo.

4
Hours Per Week:_________
Reason For Leaving:

graduating

Academic Mentor Club

volunteer
President of Mentor Club
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Organize papers, plan meetings, type attendance

reports and use of google excel and forms

_________________________________________________

205 W Olive Ave

Merced, CA, 95348

(209)385-6465

_________________________________________________

Supervisors Name:
Yer Lawson
________________________________________________

_________________________________________________

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

Phone

(559) 917-8148

Occupation_______

ROP Instructor

Merced, CA, 95341

________________________________________________________________________________________________________________________________
2. Tammie

Meyer

205 W Olive Ave

(209)756-0891
Teacher

Merced, CA, 95348

________________________________________________________________________________________________________________________________
3.

Samantha Moreno

1 W Main St

(209)446-0121

Merced, CA 95340

Phone Technician

________________________________________________________________________________________________________________________________

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