ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Barragan Alejandro M ____________________
5-12-19
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

3829 N Golden Bear Dr.
(P.O. Box or Street Number)

Merced California 95340

_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 261-6908 ( 209 )____________________

724-0439 ____________________________
[email protected]
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Dental office assistant

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

Bilingual, friendly, dependable, responsible, puntual, fast learner, typing (40+ wpm), positive attitude, good
communication skills, easy going, strong work ethic

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 _______________________
Y4728379
(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 yes Highscool
diploma

College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
ASB student government, science club, Leo club, Merced High Tech team, Saint Patrick's youth group

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

6am-12pm 6pm-10pm 6pm-10pm 6pm-10pm 6pm-10pm 6pm-12pm 6am-12pm

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:
Mercy Hospital Volunteer
Title__________________________Last $0
Salary: _____________
Mercy Medical Center
_________________________________________________
6/2017
______ 2/2019
______
Mo / Yr Mo/Yr
Duties
333 Mercy Ave, Merced, Ca, 95340
_________________________________________________
1
Total ____Yrs. 8
________Mo.
Escorting patients from rooms to cars for discharge, (209) 564-5000
_________________________________________________
4
Hours Per Week:_________ greeting guests and providing wrist bands for visitors
Reason For Leaving: _________________________________________________
Leaving for college to new
Supervisor’s Name: _________________________________________________
city
Jan Sorge
_____________________________________________________

From: To:
$0 Our Lady of Mercy school
Teachers Aide
Title__________________________Last Salary: _____________ _________________________________________________
8/2015
______ 10/2016
______
Mo/ Yr Mo/Yr Duties:
1400 E 27th St, Merced, CA 95340
_________________________________________________
1
Total ____Yrs. 2
________Mo. Assisting teacher and directing children 209) 722-7496
_________________________________________________
2
Hours Per Week:_________
Reason For Leaving: _________________________________________________

looking for volunteer _________________________________________________

service with more Supervisor’s Name:
application towards career Deborah Rose
________________________________________________

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.
Jan Sorge Merced, Ca 95340 (209)769-1884
volunteer advisor
________________________________________________________________________________________________________________________________

2. Haydee Arreola Merced, CA 95340 (209) 620-9806

Activities Director
________________________________________________________________________________________________________________________________

3. Stephen Eccles Merced, CA 95340 [email protected]

Science 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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