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ROP APPLICATION
Directions: Please Print Legibly
Edward
M.
Name: Leyco
__________________________________________

(Last)

(First)

May 4, 2014
____________________

(Middle)

Date

4038 Sisteron Ct.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95348
_______________________________________________________________________________

(City)

(209 ) 819-8718

(State)

(Telephone Number)

(Zip Code)

)____________________ ezteaed@gmail.com
____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

Skills and/or competencies which qualify you for this position:
Able to set up a sound system, People skills, Proficient with math, Proficient Art Skills, Able to perform in
front of crowds

Bisaya, Tagalog, Spanish

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

City/State

Course of
study or
major

High School

Last year
completed

Did you
graduate?

Diploma
or degree

Yes

Diploma

1 2 3 4

Merced High School

Merced/CA

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Student Government Tech. (Commissioner of Technology - 2 years of Experience), Keep it Classy (Member;
Vice President), Journalism (Member) Kiwins (Member), Interact (Member), Choir (3 years), Jazz Vocal (2
years)
FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

WEDNESDAY

PART TIME

THURSDAY

FRIDAY

SATURDAY

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Title__________________________Last Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

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

Complete Address (Include City, State, Zip)

Phone

Occupation_______

1.

Haydee Arreola-Tovar

(209) 648-7220

Director of Activities

________________________________________________________________________________________________________________________________
2.

Brad Reed

(209) 201-9718

Choir Director

________________________________________________________________________________________________________________________________
3.

Mr. Barber

(209) 761-2352

Barbershop Mentor

________________________________________________________________________________________________________________________________

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