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ROP APPLICATION
Directions: Please Print Legibly
Xiong
Vanessa
Name: __________________________________________

(Last)

(First)

01/20/16
____________________

(Middle)

Date

97 East La Purisima Street

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95341
merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 381-0468

(Zip Code)

laughter_smile94@yahoo.com
N/A
(
)____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

sales associate
Position applied for:_______________________________________________________________

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

well organize and focus

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

Hmong
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

_______________________
N/A
(Number)

RECORD OF EDUCATION

High School

Name of School

City/State

merced high school

merced, CA

College/
University

N/A

Other
(Specify)

N/A

Course of
study or
major
general
education

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

pending
2016

pending
2016

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

1:00 - 4:00

MONDAY

3:30 - 7:30

TUESDAY

3:30 - 7:30

WEDNESDAY

3:30 - 7:30

THURSDAY

3:30 - 7:30

FRIDAY

3:30 - 7:30

PART TIME

SATURDAY

1:00 - 4:00

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

rop
employee
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

pocket check, customer service, fitting room

_________________________________________________

To:

09/15
______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

1386 W Olive Ave

Hours Per Week:_________

Reason For Leaving:

From:

Rainbow

(209) 726-8715

_________________________________________________
Supervisors Name:
tammy
_____________________________________________________

_________________________________________________

Title__________________________Last
Salary: _____________
N/A

_________________________________________________

Duties:

_________________________________________________

N/A

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

Hours Per Week:_________
Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

Total ____Yrs. ________Mo.

N/A
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

N/A

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

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

Name
1.

Nathan Mckinnon

Complete Address (Include City, State, Zip)

611 W 2nd St., Merced, CA 95340

Phone

(559) 250-6950

Occupation_______

Police Officer

________________________________________________________________________________________________________________________________
2. Blia

Yang

205 W Olive Ave, Merced, CA 95348

(916) 450- 1813

Teacher

________________________________________________________________________________________________________________________________
3.

Lisa Escobedo

205 W Olive Ave, Merced, CA 95348

(209) 769-2663

ROP Instructor

________________________________________________________________________________________________________________________________

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