ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
scoggins paul james ____________________
may 1, 2017
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

1811 greensands ave
(P.O. Box or Street Number)

Atwtaer california 95301

_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 230-6155 ( )____________________ ____________________________

pscoggins500281@muhsdstudents.org
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Anesthesiologist

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

I have great leadership and dedication to fulfill this job. Everything I do I make sure I do it 100% and i am
very good with people and I often visit the Valley childrens hospital in madera CA to see how the
anesthesiologist work in person.

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 School Merced/CA 1 2 3 4 Pending Diploma
2017
College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Leadership,Community Service, Football, and Track & Field

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

8-5 8-5 8-5 8-5 8-5

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:
Activites assistant
Title__________________________Last $0
Salary: _____________
Boys & Girls Club
_________________________________________________
6/16
______ 4/17
______
Mo / Yr Mo/Yr
Duties
Merced CA, 95340
_________________________________________________
1
Total ____Yrs. ________Mo.
I led certain groups of kids to what activities they (209)722-9922
_________________________________________________
10-40
Hours Per Week:_________ would participate in after they finished their
Reason For Leaving: _________________________________________________
homework
I was getting ready to
Supervisors Name: _________________________________________________
leave for the air force soon
John Doty
_____________________________________________________

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.
Steve disalvo Merced High School Merced, CA 95340 (209)201-3784
Football coach
________________________________________________________________________________________________________________________________

2. Rob Scheidt Merced High School Merced, CA 95340 1(209)658-9517

Teacher
________________________________________________________________________________________________________________________________

3. Luke Marvulli1 Merced High School Merced, CA 95340 1(209)205-8019

Teacer
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________