ROP APPLICATION

Directions: Please Print

Legibly

Name: _​McGlothin Kalista Rae 05/20/19​________________________________________

____________________
(Last) (First) (Middle) Date

Present mailing address:___________​2957 Tenaya Drive

________________________________________________
(P.O. Box or Street Number)

___________​Merced CA , 95340
____________________________________________________________________
(City) (State) (Zip Code)

( 209)761-0401 (209)756-0512 ​Bubbles2001Kalista@gmail.com​____________________

____________________________
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_​Teaching

______________________________________________________________

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

4 years at UCSC, Worked as an intern

Languages spoken and/or written (other than English):______ ​no ​_________________________

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 ​_______________________
(Number
)

RECORD OF EDUCATION
 ?
Did you
Name of School City/State graduate
Course ?
of study Diploma
or major or
Last year degree
complete Diploma
d or
Last year degree
complete Diploma
d or
Did you degree
graduate Diploma
? or
Did you degree
graduate

High School 1 2 3 4
Universit
y
College/ 1234

1234
Other (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:

______ ______ ​Mo / Yr

Mo/Yr

Total ____Yrs.
________Mo. Supervisor’s Name:
_____________________________________________________
Hours Per _________________________________________________
Week:_________ Reason
_________________________________________________
For Leaving:
_Last Salary: _____________
_________________________________________________
_________________________________________________

_________________________________________________
 _________________________________________________

_________________________________________________ _________________________________________________
_________________________________________________

_Yrs.
From: To: _Mo.

______ ______ ​Mo/ Yr r

Mo/Yr _______ Reason
ng:
Total ____Yrs. Title___________________________Last Salary: ____________
________Mo.

Hours Per
Week:_________ Reason
For Leaving:
Title__________________________Last Salary: _____________

Supervisor’s Name:
________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Supervisor’s Name:
________________________________________________
_________________________________________________

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

From: To:

______ ______ ​Mo /Yr

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:____​5/11/19​_____________________Signature:__​Kalista McGlothin
_______________________________________________________________
N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf Revised 7/10