Professional Documents
Culture Documents
(Last)
(First)
5/5/14
____________________
(Middle)
Date
497 Occidental Ct
Present mailing address:___________________________________________________________
(City)
(209 ) 617-8063
(State)
(Telephone Number)
(Zip Code)
jellylee1203@gmail.com
)____________________ ____________________________
(Email Address)
Hmong
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:________________________________
Yes
_______________________
F4927731
(Number)
RECORD OF EDUCATION
Name of School
High School
City/State
Course of
study or
major
Merced/CA
College/
University
Last year
completed
Did you
graduate?
Diploma
or degree
1 2 3 4
Yes
Diploma
1 2 3 4
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
President of Link Crew
Interact
FULL TIME
AVAILABILITY
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
PART TIME
THURSDAY
FRIDAY
SATURDAY
_________________________________________________
Duties
_________________________________________________
To:
______
______
Mo / Yr
Mo/Yr
_________________________________________________
Hours Per Week:_________
Reason For Leaving:
From:
_________________________________________________
Supervisors Name:
_____________________________________________________
_________________________________________________
_________________________________________________
Duties:
_________________________________________________
To:
______
______
Mo/ Yr
Mo/Yr
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
_________________________________________________
Duties:
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
Phone
Occupation_______
1.
________________________________________________________________________________________________________________________________
2.
________________________________________________________________________________________________________________________________
3.
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________