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ROP APPLICATION
Directions: Please Print Legibly
Anahita
Name: Foroutanaliabad
__________________________________________

(Last)

(First)

May 11, 2015

____________________

(Middle)

Date

3851 N. Lake Rd.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95340
_______________________________________________________________________________

(City)

(State)

(559 ) 871-5280
(Telephone Number)

(Zip Code)

anahita@zymex.com
385-3696
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Internship
Position applied for:_______________________________________________________________

Skills and/or competencies which qualify you for this position:

Quick learner, organized, reliable, and have prior experience

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

_______________________
F5409662
(Number)

RECORD OF EDUCATION

Name of School

Course of
study or
major

City/State

Last year
completed

High School

Did you
graduate?

Diploma
or degree

Not Yet.

Diploma

1 2 3 4

Merced High School

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:
Clubs/Organizations- PACIFIC Club (helped special needs students), FBLA (Future Business Leaders of
America), and Book Club (of which I was both publicity and president).
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

Administrative Assistant
$0
Title__________________________Last
Salary: _____________

University
Pediatric Center
_________________________________________________

Duties

1100
Olivewood Dr.
_________________________________________________

To:

01/11
______

01/15
______

Mo / Yr

Mo/Yr

Total 4
____Yrs. ________Mo.

10
Hours Per Week:_________
Reason For Leaving:

I had to focus on college

applications and finishing
high school.
From:

I filed papers, worked the fax machine and printer,

and I answered the phone and scheduled
appointment.

Merced
CA, 95341
_________________________________________________

Supervisors Name:
Dr. Sima Asadi
_____________________________________________________

_________________________________________________

To:

01/13
______

01/15
______

Mo/ Yr

Mo/Yr

2
Total ____Yrs.
________Mo.
5
Hours Per Week:_________
Reason For Leaving:
I had to focus on college
applications and finishing
high school.
From:

(209)
383-3671
_________________________________________________

$0
Title__________________________Last
Salary: _____________
Assistant

Zymex
Industries
_________________________________________________

Duties:

168
Hawk Dr.
_________________________________________________

I helped with small jobs that needed to be done so

the business would meet their deadlines.

Merced
CA, 95341
_________________________________________________

(209)
722-2770
_________________________________________________
_________________________________________________

Supervisors Name:
Ahmad Foroutan
________________________________________________

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.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

205 W Olive Ave

Mrs. Mucci

Merced, CA 95348

(209) 385-6465

Special Ed. Teacher

________________________________________________________________________________________________________________________________
2.

205 W Olive Ave

(209) 385-6465

Ms. Morgan

Merced, CA 95348

________________________________________________________________________________________________________________________________
3.

205 W Olive Ave

(209) 385-6465

Merced, CA 95348
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

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Revised 7/10