ROP APPLICATION

Directions: Please Print Legibly

Ogden
Ogden, Lily Lily Anne
Elizabeth Elizabeth Anne
Name: __________________________________________ ____________________
April 8, 2017
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

2887 Santa Cruz Ave
(P.O. Box or Street Number)

Merced CA 95340
_______________________________________________________________________________
(City) (State) (Zip Code)

( 209 ) 6172590 ( 209 )____________________

7260203 ____________________________
lilyeaogden@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Licensed Vocational Nurse

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

Attentive, determined, self motivated, very organized, fast learner, observant, strong verbal communication,
ectremely responsible

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

NA
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
_______________________
Y2649135
(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 1 2 3 4 Diploma
Merced High School Merced/ CA In June I
will be
College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:

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:
Janitor
Title__________________________Last 90
Salary: _____________
Salon Di Capelli
_________________________________________________
7/14
______ Current
______
Mo / Yr Mo/Yr
Duties
2808 G St, Suite 2
_________________________________________________
3
Total ____Yrs. ________Mo.
Clean entire vcinity, dust, sweep, mop, wipe (209) 381-0381
_________________________________________________
12
Hours Per Week:_________ counters and clean sinks.
Reason For Leaving: _________________________________________________

Supervisors Name: _________________________________________________

Martha Souza
_____________________________________________________

From: To:
60 Not a company
Animal Caretaker
Title__________________________Last Salary: _____________ _________________________________________________
4/13
______ Current
______
Mo/ Yr Mo/Yr Duties:
1557 San Louis Obispo Ct.
_________________________________________________
5
Total ____Yrs. ________Mo. Watched over dogs and house, made sure they (209) 617- 9449 Personal cellphone
_________________________________________________
5
Hours Per Week:_________ were healthy and everything was safe and secure.
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
Kerry Spriggs
________________________________________________

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.
Kerry Spriggs 1557 San Louis Obispo Ct. Merced CA 95340
(209) 617-9449
Retired
________________________________________________________________________________________________________________________________

2. Julia Robertson 1574 Santa Inez Ct. Merced CA 95340 (209) 769- 4808
Teacher
________________________________________________________________________________________________________________________________

3. 921 Northwood Dr. Merced CA 95348 (209) 769-8675

Emili Rivera
ASL Interpreter
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

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