ROP APPLICATION

Directions: Please Print Legibly

Jones
Danielle
J
Name: __________________________________________

(Last)

(First)

5/8/14
____________________

(Middle)

Date

3283 Meadows Ave

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
merced
95348
_______________________________________________________________________________

(City)

(209 ) -233-9320
(Telephone Number)

(State)

(Zip Code)

jonez_d@yahoo.com
-947-3442
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Daycare Provider
Skills and/or competencies which qualify you for this position:
i have experience in working ina daycare
food prep. specialist

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
High School

City/State

Merced high School

Course of
study or
major

Merced CA

College/
University

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

pending
2014

pending
2014

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
i ran track
community service (fed homeless people)
FULL TIME

AVAILABILITY
SUNDAY

PART TIME

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

6:30am-10pm

---------->

------------>

------------->

----------->

10am-10pm

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

Period of Employment
From:

Company Name, Address, and Phone Number

Nov.
Daycare Provider
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

take care if children

prepare meals

_________________________________________________

To:

8/11
______

11/13
______

Mo / Yr

Mo/Yr

11
3
Total ____Yrs.
________Mo.
25
Hours Per Week:_________
Reason For Leaving:
N/A

From:

Job Title and Duties Performed

LaPatite Academy
3190 collin dr.

_________________________________________________
Supervisors Name:
Karen
_____________________________________________________

_________________________________________________

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
1.

marcus humphrey

Complete Address (Include City, State, Zip)

205 west olive

Phone

Occupation_______

209-385-6465
teacher

________________________________________________________________________________________________________________________________
2.

karen

3190 collins drive

supervisor at LPA

________________________________________________________________________________________________________________________________
3.

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________