ROP APPLICATION

Directions: Please Print Legibly

Da Costa
Jesscia
Marie
Name: __________________________________________

(Last)

(First)

April 28,2015
____________________

(Middle)

Date

3144 North G st, PMB #124

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95340
_______________________________________________________________________________

(City)

(209 ) 233-4452
(Telephone Number)

(State)

(Zip Code)

dacosta97_jessica@hotmail.com
N/A
(
)____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Veterianarian Assistant
Skills and/or competencies which qualify you for this position:
I have taken ROP vet science for a year at Merced HIgh School
I have raised animals for two years at Merced Fair

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

Last year
completed

Did you
graduate?

Diploma
or degree

n/a

1 2 3 4

yes

diploma

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:
Merced FFA

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

8a.m-10p.m

8a.m-9p.m

8a.m-9p.m

8a.m-9p.m

8a.m-9p.m

8a.m-9p.m

8a.m-10p.m

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

3,000
Cashier
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Handle the cashier, take orders, help customers,

make fries, clean store, and stock appliances.

_________________________________________________

To:

7/14
______

present
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

30
Hours Per Week:_________
Reason For Leaving:
Currently still working

From:

Mc Donalds

314 Olive Ave Merced, Ca 95348

(209)-385-7610

_________________________________________________
Supervisors Name:
Yenia Garcia
_____________________________________________________

_________________________________________________

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.

Jaynie Booth

Complete Address (Include City, State, Zip)

716 Belvue Dr. Merced CA 9540

Phone

Occupation_______

(209)-233-5198
Cashier

________________________________________________________________________________________________________________________________
2. Noel

Garcia

348 Olive Ave Merced CA 95340

(209)-756-4358
Manager

________________________________________________________________________________________________________________________________
3. Felisa

Sanches

921 University ct. Merced CA 95340

(209)-261-5391
Cheer Coach

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________