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ROP APPLICATION
Directions: Please Print Legibly
Treyvon
J.
Name: Singleton
__________________________________________

(Last)

(First)

2/2/2015
____________________

(Middle)

Date

1173 Crescent Dr.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95348
_______________________________________________________________________________

(City)

(State)

(228 ) 264-0173

(Telephone Number)

(Zip Code)

)____________________ tsingleton104964@muhsdstudents.or
____________________________

(Alternative Telephone Number)

(Email Address)

Sales Associate
Position applied for:_______________________________________________________________

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

Friendly, Focused, Cooperative, Organized

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

Did you
graduate?

Diploma
or degree

Pending

Pending

1 2 3 4

Merced High School

College/
University

Last year
completed

Merced, CA

General
1 2 3 4

N/A

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Varsity Basketball and Track

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

9a.m.-Closing

4p.m-10p.m.

4p.m-10p.m.

4p.m-10p.m.

4p.m-10p.m.

4p.m-10p.m.

4p.m-10p.m.

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.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

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.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

865 Alexander Dr, Jackson, Ms 39206

Deborah Smith

(601)254-6526

Teacher

________________________________________________________________________________________________________________________________

1020 Blackbird Ave, Jackson, Ms 39206

2.

(601) 322-6882

James McCanon

Basketball Coach

________________________________________________________________________________________________________________________________

205 West Olive Avenue, Merced, CA 95348

3.

Richard Jones

(209) 385-6465

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