Job Application
Job Application
(Last)
(First)
(Middle)
Date
(City)
(209 ) 631-3344
(Telephone Number)
(State)
(Zip Code)
[email protected]
722-5016
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)
Spanish
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:________________________________
Yes
_______________________
(Number)
RECORD OF EDUCATION
Name of School
High School
College/
University
City/State
Course of
study or
major
Last year
completed
Did you
graduate?
Diploma
or degree
Merced, CA
Gen Ed.
1 2 3 4
Pending
June 2014
Diploma
Merced College
Merced, CA
History
1 2 3 4
Will start in
Fall 2014
Seeking
A.A.
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
Participated in the Oral History Project for the Merced Courthouse Museum in May 2013.
FULL TIME
AVAILABILITY
PART TIME
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
1PM-5PM
1PM-5PM
1PM-5PM
1PM-5PM
1PM-5PM
1PM-5PM
1PM-5PM
_________________________________________________
Duties
_________________________________________________
To:
______
______
Mo / Yr
Mo/Yr
_________________________________________________
Hours Per Week:_________
Reason For Leaving:
From:
_________________________________________________
Supervisors Name:
_____________________________________________________
_________________________________________________
_________________________________________________
Duties:
_________________________________________________
To:
______
______
Mo/ Yr
Mo/Yr
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
_________________________________________________
Duties:
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
John Kane
Phone
Occupation_______
Teacher
________________________________________________________________________________________________________________________________
2. Kelsey
Thomas
Teacher
________________________________________________________________________________________________________________________________
3. Steve
DiSalvo
Teacher
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________