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ROP APPLICATION
Directions: Please Print Legibly

____________________
March 23, 2016

Name: __________________________________________
Rios
Angela
Renee
(Last)

(First)

(Middle)

Date

Present mailing address:___________________________________________________________

2667 Mira Ct.
(P.O. Box or Street Number)

CA
95341
Merced
_______________________________________________________________________________
(City)

( 209) 261-6175

(State)

(Telephone Number)

(Zip Code)

)____________________
____________________________
angela.rios@campus.mccd.edu
N/A

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

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

Active Listener, Speaking, Coordination, and Service Orientation.

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:________________________________

N/A

Do you possess a valid California Drivers License?

No

Yes

_______________________
N/A
(Number)

RECORD OF EDUCATION

High School

College/
University
Other
(Specify)

Course of
study or
major

Name of School

City/State

Merced High School

Merced, CA

General
Education

Merced Community
College

Merced, CA

Breadth
Requirements

N/A

N/A

N/A

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

Pending
2016

Pending
2016

N/A

N/A

N/A

N/A

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

Marketing.

AVAILABILITY
SUNDAY

Open-10pm

MONDAY

--------

TUESDAY

4pm-10pm

WEDNESDAY

---------

FULL TIME
PART TIME

THURSDAY

4pm-10pm

FRIDAY

4pm-Close

SATURDAY

Open-Close

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

Period of Employment

Job Title and Duties Performed

Company Name, Address, and Phone Number

Child care
Non-paid
Title__________________________Last
Salary: _____________

Muhsd Child Development Center

_________________________________________________

Duties

_________________________________________________

10
Hours Per Week:_________
Reason For Leaving:

Playing with children, cleaning toys, changing

diapers, feeding breakfast and lunch, and clean-up.

1900 G Street, Merced, CA, 95340

_________________________________________________

Volunteer for my
senior year

Supervisors Name:
Graciela Ojeda
_____________________________________________________

From:

To:

8/15
______

5/16
______

Mo / Yr

Mo/Yr

0
9
Total ____Yrs.
________Mo.

From:

_________________________________________________

(209)385-6440
_________________________________________________

To:

N/A
______

N/A
______

Mo/ Yr

Mo/Yr

N/A
Title__________________________Last
Salary: _____________
N/A

_________________________________________________

Duties:

_________________________________________________

N/A
N/A ________Mo.
Total ____Yrs.

N/A

_________________________________________________

N/A

Hours Per Week:_________

N/A
Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
N/A
________________________________________________

N/A

From:

To:

N/A
______

N/A
______

Mo /Yr

Mo/Yr

N/A
N/A
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

N/A

N/A ________Mo.
N/A
Total ____Yrs.

N/A
Hours Per Week:_________
Reason For Leaving:

_________________________________________________

N/A
_________________________________________________

Supervisors Name:
N/A
________________________________________________

N/A

_________________________________________________

REFERENCES: Give the names of three persons not related to you.

Name
1.

Anna Votaw

Complete Address (Include City, State, Zip)

Universal Service Recycling Center

Phone

(559)416-2923

450 North Tower Road, Merced, CA, 95341

Occupation_______

Cashier

________________________________________________________________________________________________________________________________
2. Theresa

Ultreras

Universal Service Recycling Center

(209)617-7551

Yosemite High School

(209)769-2582

Assistant
450
North
Tower
Road,
Merced,
CA,
95341
________________________________________________________________________________________________________________________________
3.

Sarah Wass

1900 G Street, Merced, CA, 95340

Teacher

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

3/23/2016

Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10