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ROP APPLICATION
Directions: Please Print Legibly
Mayra
Name: Ferreira
__________________________________________

(Last)

(First)

May 9, 2014
____________________

(Middle)

Date

1055 Independence CT
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95341
_______________________________________________________________________________

(City)

(209 ) 383-0981
(Telephone Number)

(State)

(Zip Code)

Ferreiramayra89@yahoo.com
761-4074
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Therapy nurse
Position applied for:_______________________________________________________________

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

I have volunteered at Franciscan Convalescent hospital. -I have experience working with elderly seniors. - I
have been trained for CPR.

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

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

Name of School

City/State

Course of
study or
major

High School

Merced High school

Merced, CA

College/
University

General
education

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

pending
2014

diploma

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
-Volunteer experience at both Franciscan Convalescent hospital and Mercy Medical Center. -I have been
involved in athletics such as cross country.
FULL TIME

AVAILABILITY
SUNDAY

PART TIME

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

8am-4pm

8am-4pm

8am-4pm

8am-4pm

8am-4m

SATURDAY

RECORD OF EMPLOYMENT: (Begin with your most recent job)

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Hostess
8..00
Title__________________________Last
Salary: _____________

Applebees
_________________________________________________

Duties

1734
W Olive Ave, Merced CA 95348
_________________________________________________

To:

11/13
______

present
______

Mo / Yr

Mo/Yr

6
Total ____Yrs. ________Mo.
18
Hours Per Week:_________
Reason For Leaving:

From:

-Cleaning tables -Keeping good coordination Running food -Being in charge of running food to
tables -Bathroom checks

(209)
724-9930
_________________________________________________

Supervisors Name:
Cheryl
_____________________________________________________

_________________________________________________

To:

1/13
______

5/13
______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

6
Hours Per Week:_________
Reason For Leaving:

_________________________________________________

N/a
Title__________________________Last
Salary: _____________
Nurse Aide

3169
M St, Merced, CA 95348
_________________________________________________

Duties:

(209)
722-6231
_________________________________________________

Helping push patients to their rooms. -Doing

activities with the elderly folks. -Helping their every
month schuedule

_________________________________________________
_________________________________________________
_________________________________________________

Supervisors Name:
Ronel Cruz
________________________________________________
From:

To:

2/12
______

4/13
______

Mo /Yr

Mo/Yr

1
3
Total ____Yrs.
________Mo.

4
Hours Per Week:_________
Reason For Leaving:

n/a
Volunteer
Title___________________________Last
Salary: ____________

333
Mercy Avenue, Merced, CA 95340-8319
_________________________________________________

Duties:

(209)
564-5000
_________________________________________________

Discharging patients -Guiding visitors -cleaning

wheel chairs - transfering blood work to other floors

_________________________________________________
_________________________________________________

Supervisors Name:
Jan Sorge
________________________________________________

_________________________________________________

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

Name
1.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

205 W Olive Ave, Merced, CA 95348

Mayra Flores

(209) 385-6465

Spanish Teacher

________________________________________________________________________________________________________________________________

205 W Olive Ave, Merced, CA 95348

2.

(209) 385-6465

Lisa Escobedo

ROP teacher

________________________________________________________________________________________________________________________________

205 W Olive Ave, Merced, CA 95348

3.

Pos Moua

(209) 385-6465

English 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:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf

Revised 7/10