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ROP APPLICATION
Directions: Please Print Legibly

Name: __________________________________________
Jarquin Suhgeyri ____________________
March 22, 2017
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

961 W 11th St
(P.O. Box or Street Number)

Merced CA 95341
_______________________________________________________________________________
(City) (State) (Zip Code)

( 209 ) 489-41-01 ( 209 )____________________

947-86-01 ____________________________
suhgeyrij18@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

nursing aide

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

CPR/first aid, knowledge of vital signs, medical terminology, basic pharmacology, blood borne pathogens
training, HIPAA training, OSHA training, patient transfers, gait training, MS Word, Excel, and medical office
skills including translating, filling.

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
_______________________
V3465781
(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 1 2 3 4 general
Merced High School Merced, CA general Pending
June 2017
College/ 1 2 3 4
University Merced College Merced, CA nursing Aug. 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:

ROP Medical Technologies, Chemistry, Health ,Spanish.

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

10:00a-6:00p after 3:00p after 3:00p n/a after 3:00p after 3:00p 1:00p-7:00p
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
_________________________________________________
01/17
______ current
______
Mo / Yr Mo/Yr
Duties
333 Mercy Ave.
_________________________________________________
3
Total ____Yrs. ________Mo.
Vital signs, patient transfers, assisting with daily Merced, CA 95341
_________________________________________________
4.5
Hours Per Week:_________ needs, restocking supply's , pick up trays and
Reason For Leaving: (209) 564-5400
_________________________________________________
calculate intake, pass out waters and answer call
n/a lights
Supervisors Name: _________________________________________________
Rachael, Abril
_____________________________________________________

From: To:
n/a Merced Organizing Project
Canvasser
Title__________________________Last Salary: _____________ _________________________________________________
10/15
______ 11/7
______
Mo/ Yr Mo/Yr Duties:
415 W 18th St
_________________________________________________
1
Total ____Yrs. ________Mo. Merced, Ca 95341
Walk around given streets and talk to people about _________________________________________________
5
Hours Per Week:_________ 2017 propositions. And wrote down their opinions (209) 800-8846
Reason For Leaving: as well as information on where to go and vote. _________________________________________________

n/a _________________________________________________
Supervisors Name:
Crissy Gallardo
________________________________________________

From: To:
CNA
Title___________________________Last n/a
Salary: ____________
Country Villa Health Care Center
_________________________________________________
06/16
______ 08/16
______
Mo /Yr Mo/Yr Duties:
510 W 26th St
_________________________________________________
0
Total ____Yrs. 2
________Mo. Took vital signs, patient transfers, assisted with Merced, CA 95341
_________________________________________________
4
Hours Per Week:_________ daily needs, wheeled patient's around, helped (209 723-2911
Reason For Leaving: patient's in the activity room. Brushed patient's hair, _________________________________________________
calculated food intake.
n/a _________________________________________________
Supervisors Name:
Amber, Dickens
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Gerald Fragasso 2121 E. Childs Ave.
(559) 917-8148
ROP Instructor
Merced, CA 95341
________________________________________________________________________________________________________________________________

2. Holly Hasenpflug 205 W. Olive Ave. (209) 325-1041

MHS Staff
Merced, CA 95341
________________________________________________________________________________________________________________________________

3. 415 W 18th St. (209) 626-0631

Crissy Gallardo
Coordinator
Merced, CA 95341
________________________________________________________________________________________________________________________________

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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