ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Torres Daniela ____________________
5/13/2019
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

3233 Cheyenne Dr.
(P.O. Box or Street Number)

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

(209 ) 500-8332 ( 209 )____________________

201-9160 ____________________________
danielatorres768@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Assistant Nursing

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

Good communication
Biligual Speaker
Fast Learner

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 _______________________
(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 1 2 3 4 Yes Diploma

College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

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

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

4-9 4-9 4-9 4-9 4-9

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:
Voluteer
Title__________________________Last Salary: _____________
Mercy Medical Center Merced
_________________________________________________
3/19
______ 5/19
______
Mo / Yr Mo/Yr
Duties
333 Mercy Ave, Merced, CA 95340
_________________________________________________
2
Total ____Yrs. ________Mo.
Answer calls (209) 564-5000
_________________________________________________
3
Hours Per Week:_________ Attend Patients
Reason For Leaving: _________________________________________________

Supervisor’s Name: _________________________________________________

Vigirna
_____________________________________________________

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

_________________________________________________
Supervisor’s Name:
________________________________________________

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

_________________________________________________
Supervisor’s Name:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Krista Leontiff
Teacher at Merced H
________________________________________________________________________________________________________________________________

2.

________________________________________________________________________________________________________________________________

3.

________________________________________________________________________________________________________________________________

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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