ROP APPLICATION

Directions: Please Print Legibly

Cooksey
Breanna
Lynn
Name: __________________________________________

(Last)

(First)

04-18-16
____________________

(Middle)

Date

3386 G Street Apt D

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95340
_______________________________________________________________________________

(City)

(State)

(209 ) 205-6919

(Telephone Number)

(Zip Code)

cookie55859@yahoo.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

Classroom Assistant
Skills and/or competencies which qualify you for this position:
Ability to speak clearly and concisely using standard English
Teaching/Tutoring
Ablility to interact positively with people of both genders, all ages, and different cultural backgrounds
NA
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

Name of School
High School

City/State

Merced High School

Course of
study or
major

Merced,
California

General
Education

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Pending:
June 2016

Diploma

College/
University

N/A

1 2 3 4

Other
(Specify)

N/A

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Foundations in Education Class, Pacific Club, FHA-HERO

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

N/A

3:30-6:00

3:30- 6:00

3:30-6:00

3:30-6:00

3:30-6:00

N/A

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

N/A
Classroom Assistant
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To help students achieve in their ability in learning.

_________________________________________________

To:

11/14
______

06/15
______

Mo / Yr

Mo/Yr

N/A
N/A
Total ____Yrs.
________Mo.

3200 Nort Parsons Avenue

4.5
Hours Per Week:_________
Reason For Leaving:

From:

Present
______

Mo/ Yr

Mo/Yr

N/A
N/A
Total ____Yrs.
________Mo.
Hours Per Week:_________
4
Reason For Leaving:

Merced, California 95340

(209) 385-6620

_________________________________________________

Mr. Vance d'Escoto, Principal

Supervisors Name:
Mrs. Waldron Kindergarten Teacher
_____________________________________________________

_________________________________________________

N/A
Title__________________________Last
Salary: _____________
Volunteer

_________________________________________________

Duties:

_________________________________________________

To help vistors with any questions they may have,

to discharge patients, and hand out vistors passes.

_________________________________________________

To:

11/14
______

Chenoweth Elementary School

Mercy Medical Center

333 Mercy Avenue

Merced, California 95340

(209) 769-1884

_________________________________________________
_________________________________________________
Supervisors Name:
Jan Sorge
________________________________________________

From:

To:

05/12
______

03/13
______

Mo /Yr

Mo/Yr

N/A
N/A
Total ____Yrs.
________Mo.

Boys and Girls Club

N/A
Volunteer
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

To help kids with homework.

_________________________________________________

615 West 15th Street

Merced, California 95340

(209) 722-9922

8
Hours Per Week:_________
Reason For Leaving:

_________________________________________________

Supervisors Name:
Ms. April Morin
________________________________________________

_________________________________________________

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

Name
1.

Judith Waldron

Complete Address (Include City, State, Zip)

Chenoweth Elementary School

Phone

Occupation_______

(209) 385-6620
Teacher

3200 North Parsons Avenue, Merced, California 95340

________________________________________________________________________________________________________________________________
2. Donna

Acheson

Merced College

(209) 631-3164
Teacher

3600 M Street, Merced, California 95348

________________________________________________________________________________________________________________________________
3. Destiny

Turner

Rivera Middle School

(209) 385-6680

945 Buena Vista Drive, Merced, California 95348

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:_________________________________________________________________