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ROP APPLICATION
Directions: Please Print Legibly
Hernandez
Saned
Salazar
Name: __________________________________________

(Last)

(First)

April 17, 2016

____________________

(Middle)

Date

1002 Cindy Ct.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA.
95340
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) -291-9821

(Zip Code)

shernandez103089@gmail.com
-206-2344
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Veterinary Assistant
Position applied for:_______________________________________________________________

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

-great with animals
-hand eye coordination
-quick on feet

-fast learner

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

Spanish
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

College/
University

N/A

Other
(Specify)

N/A

Merced, CA

Course of
study or
major
high school

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

pending

diploma

1 2 3 4

1 2 3 4

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

FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

11:00am-11:00pm 3:00-11:00pm 3:00-11:00pm

WEDNESDAY

3:00-11:00pm

PART TIME

THURSDAY

FRIDAY

3:00-11:00pm 3:00-12:00am

SATURDAY

open-closed

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
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

Title__________________________Last
Salary: _____________
N/A

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

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.

Donna Pena

Complete Address (Include City, State, Zip)

1160 W. 20th Street

Phone

(209)-631-3314

Occupation_______

PBX Operator

Merced, CA. 95340

________________________________________________________________________________________________________________________________
2. Maria

Torres

2870 St. Philip

(209)-386-2900
House keeping

Merced, CA. 95348

________________________________________________________________________________________________________________________________
3.

Clarence Denning

2401 Northridge Drive

(209)-417-8280

Modesto, CA. 95350

Service Manager

________________________________________________________________________________________________________________________________

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