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ROP APPLICATION
Directions: Please Print Legibly
Roe
Abigail
Lauren
Name: __________________________________________

(Last)

(First)

3/24/16
____________________

(Middle)

Date

3538 Sarasota Ave.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 777-4443

(Telephone Number)

(Zip Code)

abigailroe98@gmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Instructional Aide
Position applied for:_______________________________________________________________

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

Immensely patient with others,creative, calming nature--even in stressful situations, highly adaptable and
flexible, welcoming to change, good sense of humor, responsible and reliable, love for working with
children, naturally kind, pulled to help those in need

Languages spoken and/or written (other than English):___________________________________

n/a
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

Name of School

City/State

Merced high School

Merced, CA

Course of
study or
major

College/
University

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

Yes

Diploma

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
PAL in the special ed classroom at Merced High School

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

WEDNESDAY

FULL TIME
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

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.

Jesse Flores

Complete Address (Include City, State, Zip)

205 W Olive Ave., Merced, CA, 95348

Phone

jflores@muhsd.org

Occupation_______

Special Needs Teacher

(Merced High School)

________________________________________________________________________________________________________________________________
2. Sean

Lord

1920 Canal St., Merced, CA, 95340

slord@cpcmerced.o
/Director of Student Minist
rg

(Central Presbyterian Church)

________________________________________________________________________________________________________________________________
3.

Andrea DeLeon

205 W Olive Ave., Merced, CA, 95348

(Merced High School)

adeleon@muhsd.or
g
Theater Arts 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:_________________________________________________________________

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

Revised 7/10