ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
LUONG LONG HAI ____________________
MAY 13, 2019
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

3483 ARCH ROCK ST
(P.O. Box or Street Number)

MERCED CA 95340
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 564 - 9390 ( 209 )____________________

723 - 1341 ____________________________
longhluong12@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

GENERAL

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

Self motivated, ethical, positive attitude, assiduous, compassionate, perseverance

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

Vietnamese (spoken), 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 Driver’s License?

‰ No ‰ Yes _______________________
Y684253
(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 CA BIOLOGY 1 2 3 4 NO HIGH
SCHOOL

College/ 1 2 3 4
UC: LOS ANGELES CA BIOLOGY NO
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
ASB LEADERSHIP, KEY CLUB, MERCY MEDICAL CENTER, MERCED COLLEGE COMMUNITY
SERVICES, FUTURE BUSINESS LEADERS OF AMERICA, SCIENCE CLUB

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

3:30 - 7:00 3:30 - 7:00 3:30 - 7:00 3:30 - 7:00

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:
DELIVERY ASSOCIATE
Title__________________________Last N/A
Salary: _____________
FURNITURE CITY
_________________________________________________
01/13
______ present
______
Mo / Yr Mo/Yr
Duties
1125 W OLIVE AVE
_________________________________________________
7
Total ____Yrs. ________Mo.
Deliver, set up, discard old furniture, interact with 209-723-0477
_________________________________________________
2
Hours Per Week:_________ customers
Reason For Leaving: _________________________________________________

Supervisor’s Name: _________________________________________________

SEAN NGUYEN
_____________________________________________________

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

_________________________________________________
Supervisor’s Name:
________________________________________________

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

_________________________________________________
Supervisor’s Name:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Sean Nguyen 1125 W OLIVE AVE 209-769-3478
Business Owner
________________________________________________________________________________________________________________________________

2. Karen Sizemore 205 W OLIVE AVE 209-325-1000

English Teacher
________________________________________________________________________________________________________________________________

3. Haydee Arreola 205 W OLVIE AVE 209-325-1066

Activites Director
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

May 13, 2019

Date:_________________________Signature:_________________________________________________________________

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