ROP APPLICATION
Directions: Please Print Legibly
Name: __________________________________________
Slagter Juliana D. ____________________
April, 2016
(Last) (First) (Middle) Date
RECORD OF EDUCATION
Course of
study or Last year Did you Diploma
Name of School City/State major completed graduate? or degree
High School 1 2 3 4 general
Merced High Merced, CA general pending
College/ 1 2 3 4
University n/a n/a n/a n/a n/a
Other
1 2 3 4
(Specify) n/a n/a n/a n/a n/a
List appropriate extracurricular activities, clubs, organizations and courses for this position:
Golf, Junior Fair Board, Dare-2-Care. Courses: AP Government, Statistics, AP Literature and Composition,
Floral Design, Teacher's Aid.
FULL TIME
AVAILABILITY PART TIME
n/a after 2:07 after 2:07 after 2:07 after 2:07 after 2:07 10a-6p
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:
Nursing aide
Title__________________________Last n/a
Salary: _____________
Mercy Medical Center, 4th floor.
_________________________________________________
02/16
______ 05/2016
______
Mo / Yr Mo/Yr
Duties
333 Mercy Ave.
_________________________________________________
0
Total ____Yrs. 0
________Mo.
Vital signs, filing, patient histories, patient transfers, Merced, CA 95340
_________________________________________________
4.5
Hours Per Week:_________ etc.
Reason For Leaving: (209) 564-5400
_________________________________________________
course ended
Supervisors Name: _________________________________________________
Rachel Abril, RN
_____________________________________________________
From: To:
$10/hour various
babysitter
Title__________________________Last Salary: _____________ _________________________________________________
01/12
______ current
______
Mo/ Yr Mo/Yr Duties: _________________________________________________
6
Total ____Yrs. 1
________Mo. Babysit children, cook dinner, lunch, or breakfast for _________________________________________________
n/a
Hours Per Week:_________ them
Reason For Leaving: _________________________________________________
n/a _________________________________________________
Supervisors Name:
various
________________________________________________
From: To:
Cleaning Lady
Title___________________________Last $50
Salary: ____________
Maid
_________________________________________________
06/15
______ 02/16
______
Mo /Yr Mo/Yr Duties:
2623 Santa Cruz Ct.
_________________________________________________
0
Total ____Yrs. 8
________Mo. Clean and vacuum the living room, Atwater, CA, 95301
_________________________________________________
n/a
Hours Per Week:_________ clean/sweep/mop the kitchen, clean the bathroom (209) 777-4843
Reason For Leaving: _________________________________________________
Date:_________________________Signature:_________________________________________________________________
N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf Revised 7/10