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ROP APPLICATION
Directions: Please Print Legibly
Chang
Kang
Meng
Name: __________________________________________
(Last)
(First)
(Middle)
Date
1275 Wildcat Dr
Present mailing address:___________________________________________________________
(City)
( 209 ) 261-9711
(State)
(Telephone Number)
(Zip Code)
kangchang14@yahoo.com
)____________________ ____________________________
(Email Address)
Yes
If yes, explain:________________________________
Yes
_______________________
F5057411
(Number)
RECORD OF EDUCATION
Name of School
High School
City/State
Course of
study or
major
Merced, Ca
College/
University
Last year
completed
Did you
graduate?
1 2 3 4
Haven't
graduated
Diploma
or degree
1 2 3 4
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
FULL TIME
AVAILABILITY
SUNDAY
Not available
MONDAY
TUESDAY
WEDNESDAY
3:30pm - 8pm
PART TIME
THURSDAY
FRIDAY
SATURDAY
9am - 3pm
_________________________________________________
Duties
_________________________________________________
To:
______
______
Mo / Yr
Mo/Yr
_________________________________________________
Hours Per Week:_________
Reason For Leaving:
From:
_________________________________________________
Supervisors Name:
_____________________________________________________
_________________________________________________
_________________________________________________
Duties:
_________________________________________________
To:
______
______
Mo/ Yr
Mo/Yr
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
_________________________________________________
Duties:
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
Phone
Occupation_______
1.
________________________________________________________________________________________________________________________________
2.
________________________________________________________________________________________________________________________________
3.
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________
Revised 7/10