ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Cortez John Martin ____________________
4/10/17
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

2935 Lakewood CT
(P.O. Box or Street Number)

Merced CA 95348
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 233-1702 ( 209 )____________________

761-6132 ____________________________
johnmcortez7@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Mercy Hospital Internship

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

Attentive to detail, calm, collected, caring, friendly, cordial, diligent, persistent

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
Course of
study or Last year Did you Diploma
Name of School City/State major completed graduate? or degree
High School Merecd High School Merced N/A 1 2 3 4 yes yes

College/ 1 2 3 4
Merced Community College Merced N/A no no
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Merced High water polo, Merced High Swim, Interact Treasurer and Vice President, AVID VP of Community
Service, Merced High School Site Council, Certified in Standard First Aid and CPR/AED for Health Care
provider
FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

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

Period of Employment Job Title and Duties Performed Company Name, Address, and Phone Number
From: To:
Youth Decoy Agent
Title__________________________Last $60
Salary: _____________
California Department of Public Health
_________________________________________________
9/2014
______ 3/2017
______
Mo / Yr Mo/Yr
Duties
Stop Tobacco Access To Kids Enforcement Unit
_________________________________________________
2
Total ____Yrs. 6
________Mo.
Attempting to buy tobacco products from stores, (STAKE)
_________________________________________________
1
Hours Per Week:_________ wearing a wire, conducting undercover operations
Reason For Leaving: Food and Drug Branch
_________________________________________________
No longer qualified upon (916) 650-6500
Supervisors Name: _________________________________________________
turning 18
Bensen J. Yee
_____________________________________________________

From: To:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo/ Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
________________________________________________

From: To:
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
John Wendel 205 W Olive Ave, Merced, CA 95348 209-325-1000
Teacher
________________________________________________________________________________________________________________________________

2. Christopher Grattan 205 W Olive Ave, Merced, CA 95348 209-325-1000

Teacher/Coach
________________________________________________________________________________________________________________________________

3. Lindsey Gentry 205 W Olive Ave, Merced, CA 95348 209-325-1000

Teacher/AVID
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________