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ROP APPLICATION
Directions: Please Print Legibly
Pena
Victor
Armando
Name: __________________________________________

(Last)

(First)

February 26 2016
____________________

(Middle)

Date

111 Emerald Drive

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
95340
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 617-4302

(Telephone Number)

(Zip Code)

vpena103291@muhsdstudents.org
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Electrician
Position applied for:_______________________________________________________________

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

I've taken 4 years of electrician classes and done training.

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

City/State

Course of
study or
major

Merced high school

Merced

N/A

College/
University

Merced college

Merced

Other
(Specify)

N/A

N/A

Associate's
degree in
Electrical
Technology
N/A

High School

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

N/A

N/A

Yes

Degree

N/A

N/A

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

AVAILABILITY
SUNDAY

6am-6pm

MONDAY

6am-6pm

TUESDAY

6am-6pm

WEDNESDAY

6am-6pm

FULL TIME
PART TIME

THURSDAY

6am-6pm

FRIDAY

6m-6pm

SATURDAY

6am-6pm

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.

Alex nuno

Complete Address (Include City, State, Zip)

123 N Easy street Merced California 95340

Phone

(209) 233-5542

Occupation_______

Tilly's

________________________________________________________________________________________________________________________________
2. Rigo

garibaldi

345 W 21st street Merced California 95340

(209) 819-6102
N/A

________________________________________________________________________________________________________________________________
3.

Juan martinez

1330 San Miguel Way Merced California 95340

(209)564- 7174

Smart&Final Worker

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

2/26/2016
Date:_________________________Signature:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf

Revised 7/10