ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Neely Kaitlyn Nicole ____________________
May 8, 2019
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

205 W. Olive Ave.
(P.O. Box or Street Number)

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

(209 ) 325-1000 ( )____________________ ____________________________

kneely105345@muhstudents.org
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Nursing Assistant

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

Certified Bilingual in Spanish, very organized, strong time management skills, prompt, reliable, positive
attitude, strong leadership skills, quick learner with tenacious dedication, and willing to learn

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 Driver’s License?

‰ No ‰ Yes _______________________
L1234568
(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 Highschool 1 2 3 4 June 2019 Diploma
courses
College/ 1 2 3 4
Simpson University Redding, CA Nursing No Degree
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
2017-2018 Anatomy and Physiology Course

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Yes Yes Yes No No No Yes

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:
Golf Coach
Title__________________________Last $0
Salary: _____________
The First Tee Central Valley
_________________________________________________
03/18
______ 08/18
______
Mo / Yr Mo/Yr
Duties
400 Tuolumne Blvd.
_________________________________________________
0
Total ____Yrs. 6
________Mo.
Coaching kids about golf Modesto, CA 95351
_________________________________________________
2 hrs
Hours Per Week:_________ Teaching kids golf etiquette
Reason For Leaving: (209) 544-1780
_________________________________________________
High school golf season
Supervisor’s Name: _________________________________________________
was approaching
John Campbell
_____________________________________________________

From: To:
$0 Merced High School Athletics
Basketball Stats Keeper
Title__________________________Last Salary: _____________ _________________________________________________
11/18
______ 2/19
______
Mo/ Yr Mo/Yr Duties:
205 W. Olive Ave.
_________________________________________________
0
Total ____Yrs. 4
________Mo. Keeping player and game stats Merced, CA 95348
_________________________________________________
10
Hours Per Week:_________ Organizing player jerseys (209) 325-1000
Reason For Leaving: _________________________________________________

Season was over _________________________________________________

Supervisor’s Name:
Austin Harding
________________________________________________

From: To:
Basketball Stats Keeper
Title___________________________Last $0
Salary: ____________
Tenaya Middle School
_________________________________________________
11/17
______ 12/17
______
Mo /Yr Mo/Yr Duties:
760 W. 8th St.
_________________________________________________
0
Total ____Yrs. 2
________Mo. Keeping game stats Merced, CA 95341
_________________________________________________
8
Hours Per Week:_________ (209) 385-6687
_________________________________________________
Reason For Leaving:

Season was over _________________________________________________

Supervisor’s Name:
Mark Herfurth
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Lauren Lanum 926 Scott Rd. Merced, CA 95341 (209) 354-2700
Principle
________________________________________________________________________________________________________________________________

2. Dan Benjamin 3360 McKee Rd. Merced, CA 95340 (209) 723-4510

Retired Firefighter
________________________________________________________________________________________________________________________________

3. Austin Harding 205 W. Olive Ave. Merced, CA 95348 (209) 325-1000

Teacher
________________________________________________________________________________________________________________________________

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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