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Rop Job Application With Availability - Fillable For Website 1 - 4

Maurissa Meza has applied for a position as a clinical nurse in labor and delivery. She has experience providing patient care, assessing vital signs, and is CPR and bloodborne pathogens certified. Meza is currently employed as a cleaning lady at a dentist office in Merced, California and is pursuing a nursing diploma from Merced High School. She is available nights and weekends and has authorization to work in the United States.

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89 views

Rop Job Application With Availability - Fillable For Website 1 - 4

Maurissa Meza has applied for a position as a clinical nurse in labor and delivery. She has experience providing patient care, assessing vital signs, and is CPR and bloodborne pathogens certified. Meza is currently employed as a cleaning lady at a dentist office in Merced, California and is pursuing a nursing diploma from Merced High School. She is available nights and weekends and has authorization to work in the United States.

Uploaded by

api-314366580
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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ROP APPLICATION
Directions: Please Print Legibly
Meza
Maurissa
Name: __________________________________________

(Last)

(First)

3/23/16
____________________

(Middle)

Date

1233 Strawberry Drive


Present mailing address:___________________________________________________________

(P.O. Box or Street Number)


CA
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 233-2919

(Zip Code)

[email protected]
386-0222
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Clincal Nurse- Labor & Delivery


Position applied for:_______________________________________________________________

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


- Great communication
- CPR certified
-Vital signs assessments

- Bloodborne pathogens

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 Drivers License?


No

Yes

_______________________
F123556
(Number)

RECORD OF EDUCATION

High School

Name of School

City/State

Merced High School

Merced, CA

Course of
study or
major

Last year
completed
1 2 3 4

College/
University

Did you
graduate?

Diploma
or degree

pending

1 2 3 4

Other
(Specify)

1 2 3 4

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

FULL TIME

AVAILABILITY
SUNDAY

anytime

MONDAY

nights

TUESDAY

nights

WEDNESDAY

nights

PART TIME

THURSDAY

nights

FRIDAY

nights

SATURDAY

anytime

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


Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

$25 per hour


cleaning lady
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

clean entire dentist office

_________________________________________________

To:

07/14
______

pending
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

3180 Collins Dr #B, Merced, CA 95348

1
Hours Per Week:_________
Reason For Leaving:

From:

Norman K Thaxter, DDS

(209) 723-4268

_________________________________________________
Supervisors Name:
Norman K Thaxter
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________


Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

Title___________________________Last Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________


Reason For Leaving:

_________________________________________________
Supervisors Name:
________________________________________________

_________________________________________________

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


Name
1.

Spence Boelter

Complete Address (Include City, State, Zip)

1234 Seseame St. Merced, CA, 95348

Phone

(209) 555-4561

Occupation_______

Church Leader

________________________________________________________________________________________________________________________________
2. Norman

K. Thaxter

3180 Collins Dr. #B, Merced, CA 95348

(209) 723-4268
Manager

________________________________________________________________________________________________________________________________
3.

Addie Kilgore

135 Pineapple Dr. Merced, CA 95348

(209) 777-6778

Family Friend

________________________________________________________________________________________________________________________________

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

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