ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
De La Torre Flavio Favian ____________________
05/10/2019
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

3456 San Lorenzo Way
(P.O. Box or Street Number)

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

(209 ) 261-9038 ( 209 )____________________

233-4072 ____________________________
delatorreflavio@ymail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Hospital Ward Clerk

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

Great Customer Service, Fast Learner, Great Cash Management , Good Rule Follower, Amazing
Organization Skills.

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, CA 1 2 3 4 No N/A

College/ 1 2 3 4
N/A N/A N/A N/A N/A
University

Other
N/A N/A N/A 1 2 3 4 N/A N/A
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
AVID Club, CSF, Mercy Medical Center Volunteer

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Afternoon Afternoon Afternoon Afternoon Afternoon Afternoon Afternoon

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:
Front Desk Volunteer
Title__________________________Last N/A
Salary: _____________
Mercy Medical Center
_________________________________________________
05/17
______ 12/18
______
Mo / Yr Mo/Yr
Duties
333 Mercy Ave, Merced, CA 95340
_________________________________________________
1
Total ____Yrs. 7
________Mo.
Wheel Chair count, discharging patients, and (209)564-5000
_________________________________________________
4
Hours Per Week:_________ recording the name's of every visitor.
Reason For Leaving: _________________________________________________
New job found
Supervisor’s Name: _________________________________________________
Janice Sorge
_____________________________________________________

From: To:
$12 per hour Merced School Empolyees Federal Credit Union
Bank Teller
Title__________________________Last Salary: _____________ _________________________________________________
06/18
______ Present
______
Mo/ Yr Mo/Yr Duties:
1021 Olivewood Dr, Merced, CA 95348
_________________________________________________
11
Total ____Yrs. ________Mo. Helping members with cash management (209)383-5550
_________________________________________________
3
Hours Per Week:_________
Reason For Leaving: _________________________________________________

Current _________________________________________________
Supervisor’s Name:
Annie Ballard
________________________________________________

From: To:
Cashier
Title___________________________Last N/A
Salary: ____________
Victoria's Mexican Food
_________________________________________________
04/17
______ Present
______
Mo /Yr Mo/Yr Duties:
1060 W. 16th St, Merced, CA 95340
_________________________________________________
2
Total ____Yrs. 1
________Mo. Serving customers and cash management. (209)726-1907
_________________________________________________
8
Hours Per Week:_________
Reason For Leaving: _________________________________________________

Current _________________________________________________
Supervisor’s Name:
Santos De La Torre
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Janice Sorge 333 Mercy Ave, Merced, CA, 95348 (209)769-1884
Volunteer Supervisor
________________________________________________________________________________________________________________________________

2. Annie Ballard 1021 Olivewood Dr, Merced, CA, 95348 (209)383-5550

Teller Supervisor
________________________________________________________________________________________________________________________________

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

Literature 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:_________________________________________________________________