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ROP APPLICATION
Directions: Please Print Legibly
Destinee
Ann
Name: Gutierrez
__________________________________________

(Last)

(First)

2-27-2014
____________________

(Middle)

Date

1179 Loughborough Dr. Apt. #2

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95348
_______________________________________________________________________________

(City)

(State)

(209 ) 819-2198

)____________________ Dgutierrez101142@muhsdstudents.or
____________________________

(Telephone Number)

(Zip Code)

(Alternative Telephone Number)

(Email Address)

Floral Clerk
Position applied for:_______________________________________________________________

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

How to make bows, tapped wire, process flowers, make bouquets, window display, Halloween centerpiece,
properly arrange flowers, and work well with other people.

N/A
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

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Merced High

Merced, C.A.

In process

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
FFA my senior year, and show a market pig in Merced High in June 2014

FULL TIME

AVAILABILITY
SUNDAY

PART TIME

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

4:30-7

4:30-7

4:30-7

4:30-7

4:30-7

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

Mowing lawn
$20
Title__________________________Last
Salary: _____________

Jesse
& Devina Garza
_________________________________________________

Duties

2780
Stonybrook Ave. Merced, C.A. 95348
_________________________________________________

To:

7/12
______

7/13
______

Mo / Yr

Mo/Yr

Total 1
____Yrs. ________Mo.

2 1/2
Hours Per Week:_________
Reason For Leaving:

I started regular school

again at MHS instead of
Independent Studies
From:

Mow front and back yards, edge, cut weeds, trim

bushes, rack leafs, pick up tree branches, blow leafs

(209)
756-7504 Devina Garza Cell
_________________________________________________

Supervisors Name:
Jesse and Devina Garza
_____________________________________________________

_________________________________________________

To:

4/12
______

5/13
______

Mo/ Yr

Mo/Yr

1
Total ____Yrs.
________Mo.
9
Hours Per Week:_________
Reason For Leaving:

(209)
756-7503 Jesse Garza Cell
_________________________________________________

$75
Title__________________________Last
Salary: _____________
Clean House

James
Smith
_________________________________________________

Duties:

1510
W. 19th Street Merced, C.A. 95340
_________________________________________________

Clean the bathroom, kitchen, front room, his room

vacuum the floors in each room, do the dishes, get
the mail, and rearrange furniture if needed.

I was no longer needed.

(209)
201-6972 Cell
_________________________________________________
_________________________________________________
_________________________________________________

Supervisors Name:
James Smith
________________________________________________
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
1.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

205 W. Olive Ave. Merced, C.A. 95344

Val Fogelberg

(209) 385-6465

T.A. Teacher

________________________________________________________________________________________________________________________________

205 W. Olive Ave. Merced, C.A. 95344

2.

(209) 385-6465

Kelsey Thomas

Photo. Teacher

________________________________________________________________________________________________________________________________

205 W. Olive Ave. Merced, C.A. 95344

3.

Amanda Galan

(209) 385-8029

Floral 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