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ROP APPLICATION
Directions: Please Print Legibly
martinez
juan
Name: __________________________________________

(Last)

(First)

3/1/16
____________________

(Middle)

Date

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)
ca
95341
merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 5647171

(Telephone Number)

(Zip Code)

juan70288@gmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Diesel-Ag Equipment Service Tech

Position applied for:_______________________________________________________________

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

some skills you need to know is knowledge about how to do things or how to take engines apart.
also you need to know all the names of tools and sizes
and the last thing you need to know is safety;this job is to risky to not know how to work safe

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

High School

College/
University

Name of School

City/State

merced high school

merced CA

UTI

sacramento CA

Course of
study or
major
GET
PASSED
HIGH
SCHOOL
Diesel-Ag

Equipment
Service
Tech

Other
(Specify)

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

yrs getting
their

1 2 3 4

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
i was in ffa welding department in high school for 3 years .
i also was in a competition representing merced high school for skills usa

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

PART TIME

WEDNESDAY

FULL TIME

THURSDAY

FRIDAY

SATURDAY

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

Period of Employment
From:

Job Title and Duties Performed

To:

$10 h
service clerk
march 14 2015 ______
march 2 2016Title__________________________Last Salary: _____________
______
Mo / Yr

Mo/Yr

1
Total ____Yrs. ________Mo.

28
Hours Per Week:_________
Reason For Leaving:

From:

Company Name, Address, and Phone Number

Address: 1425 Martin Luther King JR., WAY, Merced,

_________________________________________________

Duties

_________________________________________________

do a cart run
help the cashers
help people around the store
clean the restrooms
Supervisors
Name:
take out the trash
_____________________________________________________

_________________________________________________

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

Complete Address (Include City, State, Zip)

merced ca

Phone

Occupation_______

{209} 2335542

________________________________________________________________________________________________________________________________
2. rafa

merced ca 553 10 st

(209) 386 21121

________________________________________________________________________________________________________________________________
3.

victor

merced ca 111 emerald drive i dont know

(209) 617 4302

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10