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ROP APPLICATION
Directions: Please Print Legibly
Leon
Ivan
Name: __________________________________________

(Last)

(First)

04/17/2016
____________________

(Middle)

Date

2020 W st
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95340
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 756-6245

(Telephone Number)

(Zip Code)

ileon103552@muhsdstudents.org
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

SMOG Technician
Position applied for:_______________________________________________________________

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

I have received my certification and have my license. I have worked with multiple car before and I love
helping others.

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

Spansih
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

_______________________
F7453649
(Number)

RECORD OF EDUCATION

High School

College/
University

Name of School

City/State

Merced High School

Merced,CA

Sacramento State

Sacramento, CA

Course of
study or
major

Last year
completed
1 2 3 4

Business

Other
(Specify)

1 2 3 4

Did you
graduate?

Diploma
or degree

yes

Diploma

Pending

Degree

1 2 3 4

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

FULL TIME

AVAILABILITY
SUNDAY

no

MONDAY

yes

TUESDAY

yes

WEDNESDAY

yes

THURSDAY

yes

FRIDAY

yes

PART TIME

SATURDAY

no

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.

Pedro Nuno

Complete Address (Include City, State, Zip)

Merced, CA 95340

Phone

(209)381-0200

Occupation_______

Entrepenuer

2329 P st

________________________________________________________________________________________________________________________________
2. Kelsey

Thomas

Merced, CA 95348

kthomas@muhsd.or
Teahcer
g

205 W Olive Ave.

________________________________________________________________________________________________________________________________
3.

James Holland

Merced, CA 95348

205 W Olive Ave.

Jholland@muhsd.or
g
Teacher

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

4/17/2016
Date:_________________________Signature:_________________________________________________________________

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

Revised 7/10