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ROP APPLICATION
Directions: Please Print Legibly
Solis
Elizabeth
Name: __________________________________________

(Last)

(First)

3/7/16
____________________

(Middle)

Date

1350 Plymouth Ave

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
95301
Atwater
_______________________________________________________________________________

(City)

(State)

( 209 ) 812-4386

(Zip Code)

esolis103387@muhsdstudents.org
658-4064
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

Animal Care Specialist I/II- Extra Help Animal Care Specialist I/II
Skills and/or competencies which qualify you for this position:
Communication, Positive Attitude, Computer and Technical Literacy, Planning/ Organizing, Creativity, and
Reliability

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

Name of School

City/State

Merced High School

Merced/ CA

Course of
study or
major

Last year
completed

General
Education

College/
University

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:
Future Farmers of America, Key Club, Pacific Club, National Society of High School Scholars, Hospital
Volunteer, Farmers' Market, Track and Field

AVAILABILITY
SUNDAY

7am- 5pm

MONDAY

7am- 5pm

TUESDAY

7am- 5pm

WEDNESDAY

7am- 5pm

FULL TIME
PART TIME

THURSDAY

7am- 5pm

FRIDAY

7am- 5pm

SATURDAY

7am- 5pm

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Hospital Volunteer
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Responsibilities include working at the information

desk, providing directions and information,
maintaing records of visitors in and out the hospital.

_________________________________________________

Supervisors Name:
Jan Sorge
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

07/14
______

08/16
______

Mo / Yr

Mo/Yr

1
1
Total ____Yrs.
________Mo.

4
Hours Per Week:_________
Reason For Leaving:
Started joining other clubs.

From:

Mercy Medical Center

333 Mercy Avenue
Merced CA 95340
(209)564-5000

_________________________________________________

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.

Jan Sorge

Complete Address (Include City, State, Zip)

333 Mercy Avenue

Phone

(209) 564-5000

Occupation_______

Volunteer Advisor

Merced, CA, 95340

________________________________________________________________________________________________________________________________
2. John

Rivero

205 W Olive Avenue

(209) 385-6465
Mathematics Instructor

Merced, CA, 95348

________________________________________________________________________________________________________________________________
3.

Christine Nicholson

P.O. Box 43 Cathey's Valley

(209) 617- 4645

Mariposa, CA, 95306

ASB Secretary

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________
4/4/2016

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

Revised 7/10