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ROP APPLICATION
Directions: Please Print Legibly
Torrens
Haley
LeAnn
Name: __________________________________________

(Last)

(First)

4-4-16
____________________

(Middle)

Date

1145 Neva Ct.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95341
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 777-5128

(Zip Code)

haley.torrens55@gmail.com
N/A
(
)____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

Team member
Skills and/or competencies which qualify you for this position:
I am a very punctual, hardworking,and an outgoing person. I like to work with others and work as a team. I
strongly believe that everyone should be treated with respect, and I respect the opinions and choices of
others.I am a fast learner, and I aim to please.

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

_______________________
F8205408

(Number)

RECORD OF EDUCATION

High School

College/
University

Course of
study or
major

Name of School

City/State

Merced High School

Merced CA

General
ED

N/A

N/A

N/A

Last year
completed
1 2 3 4

1 2 3 4

Other
(Specify)

Did you
graduate?

Diploma
or degree

In proccess Almost

No

No

1 2 3 4

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

FULL TIME

AVAILABILITY
SUNDAY

Any time

MONDAY

3- close

TUESDAY

3- close

WEDNESDAY

3- close

THURSDAY

3- close

FRIDAY

3- close

PART TIME

SATURDAY

Any time

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

Period of Employment

Job Title and Duties Performed

Company Name, Address, and Phone Number

$10 hour
House Cleaning
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Vacuuming, mopping, cleaning bathrooms, cleaning

rooms, sweeping, dusting, and anything else the
employer needs.

_________________________________________________

Supervisors Name:
Carol Barioni
_____________________________________________________

_________________________________________________

$10 hour
Title__________________________Last
Salary: _____________
Baby Sitter
June 5th 2015
July 11th 2014 ______
______
Mo/ Yr
Mo/Yr
Duties:

_________________________________________________

From:

To:

June 10th 2015 ______

Current
______
Mo / Yr

Mo/Yr

1
Total ____Yrs.
________Mo.

2
Hours Per Week:_________
Reason For Leaving:
Still employed.

From:

1247 El Portal Dr. Merced CA 95340

To:

1
Total ____Yrs.
________Mo.
Hours Per Week:_________
6-7
Reason For Leaving:

House Keeper

Diaper child, feed child, give him baths, entertain

with books, movies and games, put to bed.

(209)723-5508

_________________________________________________

Baby Sitter

Moved N/A address

_________________________________________________

(209)259-8272

_________________________________________________
_________________________________________________
_________________________________________________

She moved.
Supervisors Name:
Jackie Ulmer
________________________________________________
From:

To:

______

______

Mo /Yr

Mo/Yr

N/A
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.

Jackie Ulmer

Complete Address (Include City, State, Zip)

5637 Aspen Ct, Riverbank CA 95367

Phone

(209)259-8272

Occupation_______

Retired

________________________________________________________________________________________________________________________________
2. Carol

Barioni

1247 El portal Dr, Merced CA 95340

(209)723-5508
Store Owner

________________________________________________________________________________________________________________________________
3.

Tammie Meyer

205 W Olive Ave, Merced, CA 95348

(209)756-8901

Teacher

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

4/4/2016
Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10