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ROP APPLICATION
Directions: Please Print Legibly

Name: __________________________________________
olivarez fuller madyson brittney ____________________
05-21-19
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

371 east 19th st
(P.O. Box or Street Number)

merced ca 95348
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 326-6757 ( )____________________ ____________________________

[email protected]
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Any position

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

cleaning yard maintenance Proficient use of computers and software (Microsoft and Google) Accurate
Keyboarding: 35 words per minute

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

none

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 _______________________
(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 yes 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

8am-12am 8am-12am 8am-12am 8am-12am 8am-12am 8am-12am 8am-12am

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:
Haven't had a job
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. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisor’s Name:
________________________________________________

From: To:
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisor’s Name:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
samantha downey 205 W. olive avenue 209-325-1007
teacher
________________________________________________________________________________________________________________________________

2. val fogelberg 205 W. olive avenue 209-325-1007

teacher
________________________________________________________________________________________________________________________________

3. betsy bell 205 W. olive avenue 209-325-1054

nurse
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts is cause for dismissal.

Date:_________________________Signature:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf Revised 7/10