ROP APPLICATION

Directions: Please Print Legibly

Anaya
Joseph
Soria
Name: __________________________________________

(Last)

(First)

05/09/14
____________________

(Middle)

Date

345 R Street
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95341
_______________________________________________________________________________

(City)

(209 ) 723-4928
(Telephone Number)

(State)

(Zip Code)

josephanayas1@gmail.com
658-5466
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

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

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

Merced High School

Course of
study or
major

Merced/CA

College/
University

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

yes

diploma

1 2 3 4

Other
(Specify)

1 2 3 4

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

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

5pm-10pm

5pm-10pm

5pm-10pm

5pm-10pm

5pm-10pm

5pm-10pm

10am-10pm

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

_________________________________________________

N/A

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

N/A

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

Hours Per Week:_________
Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

Total ____Yrs. ________Mo.

Title___________________________Last Salary: ____________

_________________________________________________

Duties:

_________________________________________________

N/A

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

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

Name
1.

James Barnes

Complete Address (Include City, State, Zip)

Phone

Occupation_______

(209)228-8585
Associate Director

________________________________________________________________________________________________________________________________
2. Jorge

Aguayo
Math Teacher

________________________________________________________________________________________________________________________________
3. Steve

Eccles
Science 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:_________________________________________________________________