Reset Form

Print Form

ROP APPLICATION
Directions: Please Print Legibly
Sao
Zhovannita
Kathlena
Name: __________________________________________

(Last)

(First)

4 / 11 / 16
____________________

(Middle)

Date

1854 Brookside Dr.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 500 - 7356

(Telephone Number)

(Zip Code)

leenasao369@yahoo.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

Entry-Level Biochemistry Lab Technician
Skills and/or competencies which qualify you for this position:
I took AP Chemistry and am currently taking AP Biology. I enjoy working in the lab and want to pursue a
career in biochemistry.

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

Khmer (speak) and Spanish (speak and write)
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

_______________________
F7914416

(Number)

RECORD OF EDUCATION

High School

Name of School

City/State

Merced High School

Merced

Course of
study or
major

College/
University

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

will in June
of 2016

diploma

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
AP Chemistry and AP Biology classes
after school AP Biology labs every several weeks
FULL TIME

AVAILABILITY
SUNDAY

not available

MONDAY

TUESDAY

after 4:45 pm after 4:45 pm

WEDNESDAY

after 4:45 pm

PART TIME

THURSDAY

after 4:45 pm

FRIDAY

after 4:45 pm

SATURDAY

all day

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

Period of Employment

Job Title and Duties Performed

Company Name, Address, and Phone Number

none
Cashier
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

10 - 15
Hours Per Week:_________
Reason For Leaving:

took orders, packed donuts, served customers,

made smoothies, cleaned-up, and helped prepare
for the next day

_________________________________________________

I will move out of Merced

because I will attend a
college out of town.

Supervisors Name:
Vannak Sao (father)
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

From:

To:

6/2007
______

6/2016
______

Mo / Yr

Mo/Yr

9
0
Total ____Yrs.
________Mo.

From:

Donut King's

260 W. Main St. Merced CA 95340

(209) 383-5411

_________________________________________________

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.

Pamela Bennett

Complete Address (Include City, State, Zip)

205 W. Olive Ave.

Phone

(209) 388-9249

Occupation_______

AP Biology teacher

Merced CA 95348

________________________________________________________________________________________________________________________________

205 W. Olive Ave.

school phone
AP Calculus teacher
number
Merced CA 95348
(209) 385-6465
________________________________________________________________________________________________________________________________
2. Timothy

3.

Hagerman

William Freitas

205 W. Olive Ave.

Merced CA 95348

school phone
number
(209) 385-6465

Physics 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