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ROP APPLICATION
Directions: Please Print Legibly
Kevin
Guzman
Name: Guzman
__________________________________________

(Last)

(First)

1/28/2015
____________________

(Middle)

Date

1259 West 2nd street

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95341
_______________________________________________________________________________

(City)

(209 ) 233-9170
(Telephone Number)

(State)

(Zip Code)

puyol5bartra15@gmail.com
N/A
(
)____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Cashier
Position applied for:_______________________________________________________________

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

Ability to create conversation
ability to take charge of a situation
Ability to stay calm during a stressful situation

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

Merced High School

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Pending
2015

Pending
2015

Merced California General Ed

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
-ROP
-Adventure Club
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

Open-10pm

4pm-10pm

4pm-10pm

4pm-10pm

4pm-10pm

4pm-Close

Open-close

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.

N/A

Hours Per Week:_________

Reason For Leaving:

From:

_________________________________________________
_________________________________________________

Supervisors Name:
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

N/A

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

Title___________________________Last Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Total ____Yrs. ________Mo.

N/A

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

Mark Abejuela

Merced, CA 95348

(209) 777-4999

Teacher

________________________________________________________________________________________________________________________________

205 West Olive Avenue

2.

(209) 617-4628

Lisa Escobedo

Teacher

Merced, CA 95348

________________________________________________________________________________________________________________________________

3891 Pintail Ct

3.

Yvonne Hanneman

(209) 658-7258

Merced, CA 95340

Coach

________________________________________________________________________________________________________________________________

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