ROP APPLICATION

Directions: Please Print Legibly

Hamilton
Emily
Dawn
Name: __________________________________________

(Last)

(First)

5/1/14
____________________

(Middle)

Date

7760 Walnut Avenue

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Winton
95388
_______________________________________________________________________________

(City)

(209 ) 564-0833
(Telephone Number)

(State)

(Zip Code)

emmydawn33@yahoo.com
N/A
(
)____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Internship
Skills and/or competencies which qualify you for this position:
Hardworker, Dedicated, Honest, Responsible, Good under stress

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
High School

City/State

Merced High School

Merced/CA

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

General ED

1 2 3 4

Yes

Diploma

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Soccer Team, Cross Country Team, Running Club, Enviromental Club, Link Crew

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

8am-8pm

4pm-9pm

4pm-9pm

4pm-9pm

4pm-9pm

4pm-9pm

8am-8pm

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Second Shooter
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Shooting, handling equipment

_________________________________________________

To:

3/10
______

4/14
______

Mo / Yr

Mo/Yr

1
4
Total ____Yrs.
________Mo.

7760 Walnut Ave, Winton, CA

14
Hours Per Week:_________
Reason For Leaving:
School

From:

12/13
______

Mo/ Yr

Mo/Yr

7
2
Total ____Yrs.
________Mo.

(209)349-1672

_________________________________________________
Supervisors Name:
Becca Hamilton
_____________________________________________________

_________________________________________________

Title__________________________Last
Salary: _____________
Referee

_________________________________________________

Duties:

_________________________________________________

Referee of soccer games

_________________________________________________

To:

5/11
______

Becca Hamilton Photography

Merced Youth Soccer Association

Merced CA

Hours Per Week:_________

6
Reason For Leaving:

(209)659-9949

_________________________________________________

School

_________________________________________________
Supervisors Name:
Tim Olson
________________________________________________

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.

Lance Eber

Complete Address (Include City, State, Zip)

301 Bedford Ct, Merced, CA, 95348

Phone

Occupation_______

(209)631-4941
Statisian

________________________________________________________________________________________________________________________________
2. Tim

Olson

157 Donna Drive, Merced, CA, 95340

(209)658-9949
Electrical Engineer

________________________________________________________________________________________________________________________________
3. Joshua

Espinosa

4792 19th Avenue, San Fransisco, CA

(415)272-4629
Sergeant

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________