ROP APPLICATION

Directions: Please Print Legibly

Cruz
Jesus
Name: __________________________________________

(Last)

(First)

4/23/15
____________________

(Middle)

Date

3537 Luguna CT
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95341
_______________________________________________________________________________

(City)

(209 ) 500-7126

(State)

(Telephone Number)

(Zip Code)

)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

FireFighter
Skills and/or competencies which qualify you for this position:
Work well with others and always at work on times

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:

FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

WEDNESDAY

PART TIME

THURSDAY

FRIDAY

SATURDAY

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

$9.00
Shoe Stocker
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

organize shoes

_________________________________________________

To:

2/20
______

4/30
______

Mo / Yr

Mo/Yr

2
Total ____Yrs. ________Mo.
Hours Per Week:_________
Reason For Leaving:

From:

Takens Merced Malll 209-723-4930

_________________________________________________
Supervisors Name:
Deigo Ruiz
_____________________________________________________

_________________________________________________

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.

Peter Janzen

Complete Address (Include City, State, Zip)

21 barbadis ct

Phone

Occupation_______

209-683-9405
Teacher

Merced Ca

________________________________________________________________________________________________________________________________
2. Juan

Gomez

43 West Olive st

209-233-5396
Co-Worker

Merced Ca

________________________________________________________________________________________________________________________________
3. Vincent

Perez

30 grove apt

209-230-8473

Merced Ca

Teacher Aide

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________