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ROP APPLICATION
Directions: Please Print Legibly
Miguel
Angel
Name: Vilchis
__________________________________________

(Last)

(First)

Jan. 7, 2014
____________________

(Middle)

Date

1808 Fir Ave.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Atwater
95301
_______________________________________________________________________________

(City)

(State)

(209 ) 357-1355

(Zip Code)

miguelvilchis@outlook.com
600-9066
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Crew Member
Position applied for:_______________________________________________________________

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

organization skills, customer service skills

Spanish-fluent
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

Name of School

Course of
study or
major

City/State

High School

Atwater High School

College/
University
Other
(Specify)

Atwater/CA

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Pending
Graduation

Pending
Diploma

General Ed.
1 2 3 4

N/A
1 2 3 4

N/A

List appropriate extracurricular activities, clubs, organizations and courses for this position:
ROP Marketing Foundations, FFA

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

Open - 10pm

2pm - 10pm

3pm - 10pm

2pm - 10pm

2pm - 10pm

2pm - 10pm

Open - 10pm

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Crew Member
N/A
Title__________________________Last
Salary: _____________

McDonald`s
_________________________________________________

Duties

1521
Bell Dr.
_________________________________________________

Food preparation and customer service.

Atwater,
CA 95301
_________________________________________________

To:

10/13
______

12/13
______

Mo / Yr

Mo/Yr

2
Total 0
____Yrs. ________Mo.
8
Hours Per Week:_________
Reason For Leaving:

(209)
358-7256
_________________________________________________

ROP Intern
Supervisors Name:
Angela McKellar
_____________________________________________________
From:

To:

06/11
______

present
______

Mo/ Yr

Mo/Yr

2
Total ____Yrs.
________Mo.

_________________________________________________

Volunteer
Title__________________________Last
Salary: _____________
Church Volunteer

First
Baptist Church
_________________________________________________

Duties:

500
Buena Vista Dr.
_________________________________________________

Assist with clean-up and setup music system.

Merced,
CA 95348
_________________________________________________

(209)
383-7729
_________________________________________________

1
Hours Per Week:_________
Reason For Leaving:
currently working presently

_________________________________________________
Supervisors Name:
Pastor Dominguez
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

N/A
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________

Supervisors Name:
________________________________________________

_________________________________________________

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

Name
1.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

Atwater High School

Cheryl Obayashi

2201 Fruitland Ave., Atwater, CA 95301

(209) 358-3088

ROP Instructor

________________________________________________________________________________________________________________________________

Atwater High School

2.

(209) 357-6000

Tara Ramirez

English Teahcer

2201 Fruitland Ave., Atwater, CA 95301

________________________________________________________________________________________________________________________________

Atwater High School

3.

Olga Abajuela

(209) 357-6000

2201 Fruitland Ave., Atwater, CA 95301

Math Teacher

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf

Revised 7/10