ROP APPLICATION

Directions: Please Print Legibly

Higgins
Tyler
James
Name: __________________________________________

(Last)

(First)

May 7, 2014
____________________

(Middle)

Date

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)
CA
Merced
95348
_______________________________________________________________________________

(City)

(State)

(Telephone Number)

(Zip Code)

)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

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

Basic spanish speaking skills

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

Merced CA

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

General ed

1 2 3 4

yes

degree
candidate
2

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

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

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

any

330-10

330-10

330-10

330-10

330-10

any

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

8$/hr
pizza maker
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

pizza dress, landing, sheet outs

_________________________________________________

To:

6/13
______

8/13
______

Mo / Yr

Mo/Yr

2
0
Total ____Yrs.
________Mo.
15-18
Hours Per Week:_________
Reason For Leaving:

From:

Little Caesars Lake blvd

_________________________________________________
Supervisors Name:
Charles Robbins
_____________________________________________________

_________________________________________________

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.

________________________________________________________________________________________________________________________________
2.

________________________________________________________________________________________________________________________________
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:_________________________________________________________________