ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Lamb Seth Austin ____________________
April 11,2017
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

145 W 12th St.
(P.O. Box or Street Number)

Merced Ca 95341
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 354-9843 ( )____________________ ____________________________

slambfuturenurse@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Nursing Aide

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

hCPR/First aid, knowledge of vital signs, medical terminology, basic pharmacology, blood borne pathogens
training, HIPPAA training, OSHA training, patient transgers, friendly, follow orders, team player, strive to
help, one year of helping special needs students, always take action

Languages spoken and/or written (other than English):___________________________________

N/A

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 Merced High School Merced/Ca General 1 2 3 4 Pending Diploma
June 2017
College/ 1 2 3 4
N/A
University

Other
N/A 1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
-ROP Medical Technologies
-Anatomy and Physiology

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

any any any any any any any

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:
Nursing Aide
Title__________________________Last $0.00
Salary: _____________
Mercy Medical Center
_________________________________________________
Jan.
______ May
______
Mo / Yr Mo/Yr
Duties
315 E. 13th St. Merced, Ca, 95340
_________________________________________________
0
Total ____Yrs. 3
________Mo.
Patient transfer, Vital Signs, and general patient (209) 564-4569
_________________________________________________
8
Hours Per Week:_________ care.
Reason For Leaving: _________________________________________________
N/A
Supervisors Name: _________________________________________________
April Brewer
_____________________________________________________

From: To:
$11.00 Save Mart
Service Specialist
Title__________________________Last Salary: _____________ _________________________________________________
June/15
______ June/17
______
Mo/ Yr Mo/Yr Duties:
150 W Olive Ave, Merced, Ca, 95340
_________________________________________________
2
Total ____Yrs. 0
________Mo. Take customers groceries out to ther vehicles, bag (209) 723-1032
_________________________________________________
Hours Per Week:_________ customers groceries, Retrieve carts.
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
George Soza
________________________________________________

From: To:
Baby Sitter
Title___________________________Last $0.00
Salary: ____________
Sister's House
_________________________________________________
June/16
______ July/16
______
Mo /Yr Mo/Yr Duties:
145 W. 12h St. Merced, Ca, 95341
_________________________________________________
0
Total ____Yrs. 1
________Mo. Responsible for watching, feeding my nephew _________________________________________________
18
Hours Per Week:_________
Reason For Leaving: _________________________________________________

N/A _________________________________________________
Supervisors Name:
Deziree Duran
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Laurie McLaughlin Merced High School 205 W. Olive Ave. (209) 385-6467
Teacher
Merced, Ca, 95344
________________________________________________________________________________________________________________________________

2. Tiffany Drake 346 Buena Vista Ct. (209) 383-7605

Registered Nurse
Merced, Ca, 95348
________________________________________________________________________________________________________________________________

3. Gerald Fragrasso Golden Valley High School 2121 E. Child's Ave. (559) 917-8148
Teacher
Merced, Ca, 95341
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________