ROP APPLICATION

Directions: Please Print Legibly

Cortez
Daisha
Dolores
Name: __________________________________________

(Last)

(First)

4/27/15
____________________

(Middle)

Date

1625 Loughborough Dr
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95301
_______________________________________________________________________________

(City)

(209 ) 756-9716
(Telephone Number)

(State)

(Zip Code)

daishadolores@gmail.com
756-9540
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Sales Clerk at Midas
Skills and/or competencies which qualify you for this position:
I have the skills of knowing mostly all automotive tools and appliences from taking auto mechanics for two
years in high school. Having this skill will allow me to understand a cutomer when it comes to somethings.

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

_______________________
F7526015
(Number)

RECORD OF EDUCATION

Name of School
High School

City/State

Merced High School

Course of
study or
major

Merced/CA

College/
University

General
Education

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

in process

in process

1 2 3 4

Other
(Specify)

1 2 3 4

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

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

anytime

4pm-9pm

4pm-9pm

4pm-9pm

4pm-9pm

4pm-9pm

anytime

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

Period of Employment
From:

Company Name, Address, and Phone Number

$20
Baby sitting
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

provide care for a child while their parent or

gaurdian is at work.

_________________________________________________

To:

4/12
______

now
______

Mo / Yr

Mo/Yr

3
Total ____Yrs.
________Mo.
8 hours
Hours Per Week:_________
Reason For Leaving:
currently still babysitting

From:

Job Title and Duties Performed

211 Laurel Ave Awater , (209)761-2063

_________________________________________________
Supervisors Name:
Emily Huckabee
_____________________________________________________

_________________________________________________

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.

Emily Huckabee

Complete Address (Include City, State, Zip)

Phone

Occupation_______

211 Laurel Ave, Atwater CA, 95301

________________________________________________________________________________________________________________________________
2.

________________________________________________________________________________________________________________________________
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:_________________________________________________________________