ROP APPLICATION

Directions: Please Print Legibly

Perkins
Amaretta
Marie
Name: __________________________________________

(Last)

(First)

5/5/15
____________________

(Middle)

Date

3933 Twilight Ave

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95348
_______________________________________________________________________________

(City)

(209 ) 761-6511

(State)

(Telephone Number)

(Zip Code)

perkinsamaretta@gmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

All
Skills and/or competencies which qualify you for this position:
Solid work ethic, Leadership capabilities, organization skills, moderate mathematics, basic computre
programs, trustworthiness, and the ability to work well with others.

None
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

----

1 2 3 4

Pending

Pending

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:
Drama club president, junior leadership of merced, Ap and honors courses.

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

8am-10pm

3pm-10pm

3pm-10pm

3pm-10pm

3pm-10pm

3pm-10pm

8am-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

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
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.

Julie Ransom

Complete Address (Include City, State, Zip)

--------------

Phone

Occupation_______

(209)-876-6387
Teacher

________________________________________________________________________________________________________________________________
2. Brian

Aranda

----------------

(312)-837-2374
Mentor

________________________________________________________________________________________________________________________________
3. Tammara

Allen

----------------

(209)-602-3456
Manager

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________