ROP APPLICATION

Directions: Please Print Legibly

Murakami
Sage
Mikio
Name: __________________________________________

(Last)

(First)

06/10/1997
____________________

(Middle)

Date

2217 West Cardella Road

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95348
_______________________________________________________________________________

(City)

(State)

(209 ) 777-8645

(Telephone Number)

(Zip Code)

sagemurakami@icloud.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

Assistant
Skills and/or competencies which qualify you for this position:
I believe I am qualified for this position becasuse im a great at serving others, I know how to work well with
others and communicate effectively. I have been a part of many teams and know how to handle problems
and situations and get the job done.

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

_______________________
F7083357
(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,
California

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, Merced FFA Sentinel, Merced Wrestling, Environmental club, Agricultural Leadership

FULL TIME

AVAILABILITY
SUNDAY

PART TIME

MONDAY

TUESDAY

WEDNESDAY

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

8.50$
Culinary staff
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Handling food and preparing food.

_________________________________________________

To:

06/13
______

08/13
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

40
Hours Per Week:_________
Reason For Leaving:
School

From:

Service Systems Associates

_________________________________________________
Supervisors Name:
Rus Murakami
_____________________________________________________

_________________________________________________

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.

Mr. Mua

Complete Address (Include City, State, Zip)

Phone

Occupation_______

205 West Olive Avenue

Teacher

________________________________________________________________________________________________________________________________
2. Mr.

Holland

205 West Olive avenue

Teacher

________________________________________________________________________________________________________________________________
3. Ms.

Clinton

205 West Olive Avenue

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:_________________________________________________________________