Job Application
Job Application
(Last)
(First)
05-06-2014
____________________
(Middle)
Date
(City)
(209 ) 390-8778
(State)
(Telephone Number)
(Zip Code)
[email protected]
)____________________ ____________________________
(Email Address)
Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?
No
Yes
If yes, explain:________________________________
Yes
_______________________
(Number)
RECORD OF EDUCATION
Name of School
High School
Course of
study or
major
City/State
merced california
Last year
completed
Did you
graduate?
Diploma
or degree
1 2 3 4
pending
2014
General
Education
College/
University
1 2 3 4
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
Art club, Business R.O.P, Pacific Club, Treasurer, Merced City Council helper, Host experience.
FULL TIME
AVAILABILITY
PART TIME
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
11-6
3-9
3-9
3-9
11-6
11-4
11-7
8
Host
Title__________________________Last
Salary: _____________
_________________________________________________
Duties
_________________________________________________
_________________________________________________
To:
10-2013
______
3-2014
______
Mo / Yr
Mo/Yr
seven
Total ____Yrs. ________Mo.
25
Hours Per Week:_________
Reason For Leaving:
From:
_________________________________________________
Supervisors Name:
Evan Cheng
_____________________________________________________
_________________________________________________
_________________________________________________
Duties:
_________________________________________________
To:
______
______
Mo/ Yr
Mo/Yr
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
_________________________________________________
Duties:
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
Erika Guzman
Phone
Occupation_______
(209)722-4046
care giver
________________________________________________________________________________________________________________________________
2. Tom
Fife
(209)201-9678
Doctor
________________________________________________________________________________________________________________________________
3. Angelina
Loa
(209)383-7823
Artist
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________