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Rop Job Application With Availability - Fillable For Website
Rop Job Application With Availability - Fillable For Website
Name: __________________________________________
Ceja Villano Karina ____________________
4/26/17
(Last) (First) (Middle) Date
Merced CA 95348
_______________________________________________________________________________
(City) (State) (Zip Code)
RECORD OF EDUCATION
Course of
study or Last year Did you Diploma
Name of School City/State major completed graduate? or degree
High School 1 2 3 4
Merced High School Merced, CA General Pending
June 2017
College/ 1 2 3 4
University N/A N/A N/A N/A N/A
Other
1 2 3 4
(Specify) N/A N/A N/A N/A N/A
List appropriate extracurricular activities, clubs, organizations and courses for this position:
FULL TIME
AVAILABILITY PART TIME
6am - 9pm 6am - 9pm 6am - 9pm 6am - 9pm 6am - 9pm 6am - 9pm 6am - 9pm
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:
Front Office Clerk
Title__________________________Last $35.00
Salary: _____________
Tiffany Hosburgh Merced General Surgery, Inc.
_________________________________________________
2/15
______ Recent
______
Mo / Yr Mo/Yr
Duties
3351 M St., Ste. 105 Merced, California 95348
_________________________________________________
Total ____Yrs. ________Mo.
Filing, Computer Excel, (209) 384-8111
_________________________________________________
4
Hours Per Week:_________
Reason For Leaving: _________________________________________________
From: To:
$35.00 3412 Maze Blvd. 95358
Babysitting
Title__________________________Last Salary: _____________ _________________________________________________
2/15
______ Recent
______
Mo/ Yr Mo/Yr Duties:
(209)634-7253
_________________________________________________
Total ____Yrs. ________Mo. Feeding, Showering, Caring, Changing diapers _________________________________________________
6hrs
Hours Per Week:_________
Reason For Leaving: _________________________________________________
_________________________________________________
Supervisors Name:
Ana Villano
________________________________________________
From: To:
N/A
Title___________________________Last N/A
Salary: ____________
N/A
_________________________________________________
N/A
______ N/A
______
Mo /Yr Mo/Yr Duties: _________________________________________________
N/A
Total ____Yrs. N/A
________Mo. N/A _________________________________________________
N/A
Hours Per Week:_________
Reason For Leaving: _________________________________________________
N/A _________________________________________________
Supervisors Name:
N/A
________________________________________________
Date:_________________________Signature:_________________________________________________________________
N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf Revised 7/10