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ROP APPLICATION
Directions: Please Print Legibly
Name: __________________________________________
Huerta Karen - ____________________
5-13-19
(Last) (First) (Middle) Date
Present mailing address:___________________________________________________________

321 Nashville, CT
(P.O. Box or Street Number)
Merced California 95348

_______________________________________________________________________________
(City) (State) (Zip Code)
(209 ) 722-8189 ( 209 )____________________

635-7805 ____________________________
[email protected]
(Telephone Number) (Alternative Telephone Number) (Email Address)
Position applied for:_______________________________________________________________

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

Two years of FFA in High School, Monitored Children and family pets.
Languages spoken and/or written (other than English):___________________________________

Spanish, French
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 Driver’s License?

No Yes _______________________
Y9200238
(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 Merced High School Merced, CA 1 2 3 4 June 2019 Diploma
College/ 1 2 3 4
University
Other
1 2 3 4
(Specify)
List appropriate extracurricular activities, clubs, organizations and courses for this position:
FULL TIME
AVAILABILITY PART TIME
SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
Yes Yes Yes Yes Yes Yes Yes

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:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo / Yr Mo/Yr
Duties _________________________________________________
Total ____Yrs. ________Mo.
_________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________
Supervisor’s Name: _________________________________________________

_____________________________________________________
From: To:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo/ Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
_________________________________________________
Supervisor’s Name:
________________________________________________
From: To:
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
_________________________________________________
Supervisor’s Name:
________________________________________________
REFERENCES: Give the names of three persons not related to you.

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Jeff Rivero Yosemite High School 1900 G St, Merced, CA (209) 777-0854
Hstory Teacher
95340
________________________________________________________________________________________________________________________________
2. Mrs. Kathy White Merced High School 205 W. Olive Ave. Merced, CA (209) 325-1000
Business Teacher
95344
________________________________________________________________________________________________________________________________
3. Karen Sizemore Merced High School 205 W. Olive Ave. Merced, CA (209) 325-1000
Business Teacher
95344
________________________________________________________________________________________________________________________________
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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ROP APPLICATION

Directions: Please Print Legibly

Present mailing address:___________________________________________________________

Merced California 95348

(209 ) 722-8189 ( 209 )____________________

Position applied for:_______________________________________________________________

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

Languages spoken and/or written (other than English):___________________________________

Do you possess a valid California Driver’s License?

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Yes Yes Yes Yes Yes Yes Yes

Supervisor’s Name: _________________________________________________

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

I authorize investigation of all statements contained in this application.

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