ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Cortes Alejandra Belen ____________________
5/9/19
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

943 W 20th st
(P.O. Box or Street Number)

Merced CA 95340
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 355-8901 ( )____________________ ____________________________

[email protected]
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Sonography

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

expirience on radiology enviroment, associate's degree in sonography, Bachelor of science in health
sciences with a concentration in allied health.

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 college 1 2 3 4 yes Diploma
prep
College/ 1 2 3 4
Merced College Merced,CA Associate's Yes Degree
University
degree
Other
California States University Standford, CA 1 2 3 4 bachelors
(Specify)
of Stanislaus

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Medical Technology, medical club, volunteer as a CTE student at Mercy hospital

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

8am-6pm 8am-6pm 8am-5pm 8am-6pm 8am-6pm 8am-2pm

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:
Trevinos Mexican Restau
Title__________________________Last Salary: _____________
408 W Main st, Merced, CA (209)723-5610
_________________________________________________
feb,2018
______ May, 2019
______
Mo / Yr Mo/Yr
Duties _________________________________________________
1
Total ____Yrs. ________Mo.
attend the customers, constently checking on them _________________________________________________
10
Hours Per Week:_________ if they need something, take orders, keeping it
Reason For Leaving: _________________________________________________
clean.
still working
Supervisor’s Name: _________________________________________________
Nene Trevino
_____________________________________________________

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.
Andrea Ayala Merced, CA (209)261-4284
co-worker
________________________________________________________________________________________________________________________________

2. Delilah Trevino Merced, CA (209)769-2590

co-worker
________________________________________________________________________________________________________________________________

3. Ryan B. Merced, CA (209)233-2016

superviser at mercy
________________________________________________________________________________________________________________________________

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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