ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Valencia Ruben Vega ____________________
04/12/17
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

55 columbia ave
(P.O. Box or Street Number)

Merced California 95340

_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 500-7029 ( 209 )____________________

947-2700 ____________________________
rvalencia3234@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

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

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
Course of
study or Last year Did you Diploma
Name of School City/State major completed graduate? or degree
High School Merced High Merced, GED 1 2 3 4 pending diploma
California 2017
College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

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

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

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

Period of Employment Job Title and Duties Performed Company Name, Address, and Phone Number
From: To:
Dishwasher
Title__________________________Last tbh
Salary: _____________
La Morenita & Florencios
_________________________________________________
05/17
______ tba
______
Mo / Yr Mo/Yr
Duties
1352 W 13th st, Merced, CA 95341
_________________________________________________
0
Total ____Yrs. 11
________Mo.
Clean dishes, Clean work pace, help chief in some _________________________________________________
Hours Per Week:_________ duties, help waiter/waitress when needed.
Reason For Leaving: _________________________________________________

Supervisors Name: _________________________________________________

_____________________________________________________

From: To:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo/ Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
________________________________________________

From: To:
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.

________________________________________________________________________________________________________________________________

2.

________________________________________________________________________________________________________________________________

3.

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________