ROP APPLICATION

Directions: Please Print Legibly

Castillo

Ana

Yuliza

04-18-206

Name: __________________________________________
(Last)

(First)

____________________

(Middle)

Date

yulianacastillo333@gmail.com

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

2085 Beachwood Dr Merced

Ca

95348

(State)

(Zip Code)

_______________________________________________________________________________
(City)

209

658-0628

(Telephone Number)

yulianacastillo333@gmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Human Health Care

Position applied for:_______________________________________________________________

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

Communication Skills, Multitasking

Spanish
Languages spoken and/or written (other than English):___________________________________
Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?

x No

Yes

If yes, explain:________________________________

Do you possess a valid California Drivers License?

No

x Yes

_______________________
(Number)

RECORD OF EDUCATION

Name of School
High School

College/
University

City/State

Merced High

Course of
study or
major

1 2 3 4x

Merced

Sacramento State

Last year
completed

1 2 3 4

Sacramento

Other
(Specify)

Did you
graduate?

Diploma
or degree

Yes
Progress

1 2 3 4

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

Keep it Classy, ASB, Link Crew, Athletics

FULL TIME

x PART TIME

AVAILABILITY
SUNDAY

All Day

MONDAY

All Day

TUESDAY

All Day

WEDNESDAY

All Day

THURSDAY

All Day

FRIDAY

SATURDAY

All Day

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

Period of Employment
From:

Job Title and Duties Performed

To:

2/2014
______

10/2014
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

Company Name, Address, and Phone Number

NA

Volunteer
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Communicating with residents, Helping out

_________________________________________________

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.

Haydee Arreola

Complete Address (Include City, State, Zip)

205 W Olive Merced California

Phone

209-385-6465

Occupation_______

Activity Director

________________________________________________________________________________________________________________________________
2.

Antonio Ybarra

3170 M St Merced California

209-723-1056

Manager

________________________________________________________________________________________________________________________________
3.

Lindsay Gentry

205 W Olive Merced California

209-385-6465

AVID Coordinator

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

04/18/2016

Date:_________________________Signature:_________________________________________________________________