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ROP APPLICATION
Directions: Please Print Legibly
Anhad
Name: Sarang
__________________________________________

(Last)

(First)

5-2-2014
____________________

(Middle)

Date

2535 Lecco Way

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95340
_______________________________________________________________________________

(City)

(209 ) 769-9172
(Telephone Number)

(State)

(Zip Code)

anhadsa@hotmail.com
725-0725
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Chemical engineer
Position applied for:_______________________________________________________________

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

I'm hardworking, determined, and I have a strong and solid work ethic.

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:________________________________

Do you possess a valid California Drivers License?

No

Yes

_______________________
f4413258
(Number)

RECORD OF EDUCATION

Name of School

City/State

Course of
study or
major

High School

Last year
completed

Did you
graduate?

Diploma
or degree

yes

diploma

1 2 3 4

Merced High School

Merced, CA

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Link crew, avid club, CSF, environmental club

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

any time

any time

any time

any time

any time

any time

any time

RECORD OF EMPLOYMENT: (Begin with your most recent job)

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Title__________________________Last Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

Title___________________________Last Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

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

Name
1.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

2808 Park Ave, Suite C, Merced, CA - 95348

Preet Sandhu

(209) 201-6850

business owner

________________________________________________________________________________________________________________________________

2024 W. Monte Vista Ave., Turlock CA 95348

2.

(209) 201-6740

Uday Bali

engineer

________________________________________________________________________________________________________________________________

400 W 1st St, Chico, CA 95929

3.

Raj Singh

(209)769-6258

part time teacher

________________________________________________________________________________________________________________________________

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