ROP APPLICATION

Directions: Please Print Legibly

Vega
Sergio
Name: __________________________________________

(Last)

(First)

May13, 2014
____________________

(Middle)

Date

711 1/2 w 10th st

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95341
_______________________________________________________________________________

(City)

(State)

(209 ) 726-0948

(Zip Code)

svega101834@muhsdstudents.org
489-1146
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

High School Counselour
Skills and/or competencies which qualify you for this position:
Communication skills, reading and writing in spanish and english skills,

Spanish
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

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

Merced High School

Merced/CA

General

1 2 3 4

june 5

Diploma

College/
University

n/a

n/a

n/a

1 2 3 4

n/a

n/a

Other
(Specify)

n/a

n/a

n/a

1 2 3 4

n/a

n/a

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Avid, Mechaand FFA

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

8hrs

8hrs

8hrs

8hrs

8hrs

8hrs

8hrs

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

contract
assistent garder
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

n/a
______

n/a
______

Mo / Yr

Mo/Yr

n/a
n/a
Total ____Yrs.
________Mo.

blowing, cutting grass

n/a
Hours Per Week:_________
Reason For Leaving:

From:

RV's garder

_________________________________________________
_________________________________________________

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)

Magdalena Sally Martinez 711 w 10th st

Phone

Occupation_______

(2090726-0306
retire

________________________________________________________________________________________________________________________________
2.

Susana Aguirre

711 w 9th st

(209)385-6442
teacher

________________________________________________________________________________________________________________________________
3.

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________