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ROP APPLICATION
Directions: Please Print Legibly
Hedrington Shantia Alexus
Name: __________________________________________

(Last)

(First)

03/04/2016
____________________

(Middle)

Date

777 Loughborough Dr. #91

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 205-8131

(Zip Code)

hedringtonshantia@gmail.com
722-5873
( 951 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Nursing aide
Position applied for:_______________________________________________________________

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

Knowledge of medical Terminology, BLS, HIPAA and OSHA certified, Patient care skills, Vital signs, People
person, Fast learner, Hard worker

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

Merced High School

Merced

General

College/
University

Merced Junior College

Merced

Nursing

Other
(Specify)

NA

NA

NA

High School

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

Pending
2016

General

Pending
2018

AA

NA

NA

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Dare-2-Care, Anatomy, Medical Technologies

FULL TIME

AVAILABILITY
SUNDAY

Open - Closing

MONDAY

TUESDAY

WEDNESDAY

3:30pm-10pm 3:30pm-10pm 3:30pm-10pm

THURSDAY

FRIDAY

PART TIME

SATURDAY

3:30pm-10pm 3:30pm -10pm Open - Closing

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Volunteer
Nursing Aide
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Scheduling appointments, Insurance claims,

Patient Care, Follow Nurses

_________________________________________________

To:

02/2016
______

Current
______

Mo / Yr

Mo/Yr

0
Total ____Yrs.
________Mo.

6
Hours Per Week:_________
Reason For Leaving:
NA

From:

900 West Olive Ave, Suite B

12/2015
______

Mo/ Yr

Mo/Yr

2
0
Total ____Yrs.
________Mo.
Hours Per Week:_________
16
Reason For Leaving:

Merced Ca, 95348-2401

209-354-4026

_________________________________________________
Supervisors Name:
Laura Vongviengkham
_____________________________________________________

_________________________________________________

$9 hr
Title__________________________Last
Salary: _____________
Sales Associate

_________________________________________________

Duties:

_________________________________________________

Cashier, Recovery, Provide customer service,

Invoice

_________________________________________________

To:

11/2015
______

Robert J Butler MD - Internal Medicine

JCPennys

600 Merced Mall

Merced Ca, 95348

209-723-3116

_________________________________________________
_________________________________________________

Seasonal
Supervisors Name:
Araceli Martinez
________________________________________________
From:

To:

05/2015
______

06/2015
______

Mo /Yr

Mo/Yr

0
1
Total ____Yrs.
________Mo.

_________________________________________________

Duties:

_________________________________________________

Organize shoes, Provide customer service, Invoice

_________________________________________________

540 Merced Mall

10
Hours Per Week:_________
Reason For Leaving:

ROP Class Over

Takkens

Volunteer
Sales Associate
Title___________________________Last
Salary: ____________

Merced Ca, 95348

209-723-4930

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

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

Name
1.

Gerald Fragasso

Complete Address (Include City, State, Zip)

2121 E Childs Ave, Merced CA, 95348

Phone

559-917-8148

Occupation_______

ROP Medical Tech Teach

________________________________________________________________________________________________________________________________
2. Lisa

Escobedo

205 W Olive Ave, Merced CA, 95348

209-617-4628
ROP Marketing Teacher

________________________________________________________________________________________________________________________________
3.

Nakia Dickson

3170 M Street, Merced CA, 95348

209-723-1056

Hylond Health Care Advis

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts is cause for dismissal.

3/24/2016
Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10