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ROP APPLICATION
Directions: Please Print Legibly
James
Alexander
Name: Stamps
__________________________________________

(Last)

(First)

May 5, 2014
____________________

(Middle)

Date

3769 Morning Dove Ave

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95348
_______________________________________________________________________________

(City)

(State)

(209 ) 230-2150

(Zip Code)

jstamps101201@muhsdstudents.org
230-7466
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Cook
Position applied for:_______________________________________________________________

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

I understand that the work is ot be done in a speedy way that reflects the quality of your establishment. I
also understand that my work may effect the work of others, so will work as hard as possible to have a
positive effect.

N/A
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

_______________________
(Number)

RECORD OF EDUCATION

Name of School

City/State

Course of
study or
major

High School

College/
University
Other
(Specify)

Last year
completed

Did you
graduate?

Diploma
or degree

Pending

Pending

---

---

---

---

1 2 3 4

Merced High School

Merced

GED

N/A

---

---

N/A

---

---

1 2 3 4

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
N/A

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

4pm-close

4pm-close

4pm-close

4pm-close

4pm-close

4pm-close

---

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

N/A
N/A
Title__________________________Last
Salary: _____________

N/A
_________________________________________________

Duties

N/A
_________________________________________________

N/A

N/A
_________________________________________________

To:

N/A
______

N/A
______

Mo / Yr

Mo/Yr

N/A
Total N/A
____Yrs. ________Mo.
N/A
Hours Per Week:_________
Reason For Leaving:

N/A
_________________________________________________

N/A
Supervisors Name:
N/A
_____________________________________________________
From:

To:

--______

--______

Mo/ Yr

Mo/Yr

---

--Total ____Yrs.
________Mo.

N/A
_________________________________________________

---Title__________________________Last
Salary: _____________
---

-----_________________________________________________

Duties:

----_________________________________________________

----

--_________________________________________________

--Hours Per Week:_________

Reason For Leaving:

-_________________________________________________

----

-_________________________________________________
Supervisors Name:
--________________________________________________

From:

To:

------______

---______

Mo /Yr

Mo/Yr

---------Total ____Yrs.
________Mo.

---------Title___________________________Last
Salary: ____________

----_________________________________________________

Duties:

-----_________________________________________________

------

-------_________________________________________________
---------_________________________________________________

----Hours Per Week:_________

Reason For Leaving:
-----Supervisors Name:
----________________________________________________

-----------_________________________________________________

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

Name
1.

Mrs. Penny Rivas

Complete Address (Include City, State, Zip)

Phone

Occupation_______

3878 R. Street, Apt. #5

Merced CA, 95348

(209)555-3373

College Toutor

________________________________________________________________________________________________________________________________

205. W. Olive Ave.

2.

(209)385-6465

Mr. Gary Maxwell

shop Instructer

Merced CA, 95344

________________________________________________________________________________________________________________________________

205 W. Olive Ave.

3.

Mrs. Cathy White

(209)385-6564

Merced CA 95344

School Instructor

________________________________________________________________________________________________________________________________

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