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ROP APPLICATION
Directions: Please Print Legibly
Lopez
Jenny
Marie
Name: __________________________________________

(Last)

(First)

April 10, 2015

____________________

(Middle)

Date

563 Margaret Court

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95341
_______________________________________________________________________________

(City)

(State)

(209 ) 384-7266

(Zip Code)

jennyfreakinlopez@yahoo.com
325-5410
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Classroom Assistant
Position applied for:_______________________________________________________________

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

Completes work that is neat, accurate, and professional in appearance. Very punctual - always on time and
ready to perform, completes assignments on time, able to accept responsibilities for my own actions.
Demonstrates initiative, honesty, tactfulness, discretion. Works cooperatively as a team member.

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
High School

College/
University
Other
(Specify)

City/State

Course of
study or
major

Merced High School

205 West Olive Avenue

Merced,
California

General
Education

Merced College
3600 M Street

Merced,
California

Liberal
Studies

N/A

N/A

N/A

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Pending
2015

Diploma

Pending
2015

Degree

N/A

N/A

1 2 3 4

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
CTE/ROP Foundations in Education I & II, Link Crew, Academic Mentor, California Scholarship Federation
(CSF), FHA-HERO: The California Affiliate of FCCLA.
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

N/A

3:30 - 6:00

3:30 - 6:00

3:30 - 6:00

3:30 - 6:00

3:30 - 6:00

N/A

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Classroom Assistant
N/A
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To help students through one-on-one assistance

and educating them through mini projects.

_________________________________________________

To:

11/13
______

Present
______

Mo / Yr

Mo/Yr

N/A
Total N/A
____Yrs. ________Mo.
5hr20min
Hours Per Week:_________
Reason For Leaving:

N/A

From:

Chenoweth Elementary School

3200 North Parsons Avenue
Merced, California 95340
(209) 385-6620

_________________________________________________

Principal Mr. Vance d'Escoto

Supervisors Name:
Ms. Darren Sakata
_____________________________________________________

_________________________________________________

Title__________________________Last
Salary: _____________
N/A

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

N/A
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 West Olive Avenue

Donna Acheson

Merced, California 95348

(209) 631-3164

Teacher

________________________________________________________________________________________________________________________________

3200 North Parsons Avenue

2.

(209) 385-6620

Darren Sakata

Teacher

Merced, California 95340

________________________________________________________________________________________________________________________________

760 West 8th Street

3.

Derek Peterson

(209) 385-6687

Merced, California 95340

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