ROP APPLICATION

Directions: Please Print Legibly

Bowman
Dakota
Marie
Name: __________________________________________

(Last)

(First)

04/17/15
____________________

(Middle)

Date

5934 Fleming Rd.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Atwater
95301
_______________________________________________________________________________

(City)

(209 ) 658-5156
(Telephone Number)

(State)

(Zip Code)

dbowman702305@muhsdstudnets.org
201-2550
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Registered Nurse
Skills and/or competencies which qualify you for this position:
I find myself working great with individuals and communities from any background. I am able to work within
a community setting. Also, I'm well organised, confident and able to cope with potentially challenging
situations. I will be able to work independently for most of the time, although I will work as a part of a team.
N/A
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

_______________________
F5005675
(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

Not yet.

N/A

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
N/A

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

Open

Open

Open

Open

Open

Open

Open

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

$5/ Hr
Secretary
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Organize paper work, answer the phone, and do

stuff on the computer.

_________________________________________________

To:

06/13
______

06/14
______

Mo / Yr

Mo/Yr

0
1
Total ____Yrs.
________Mo.
6
Hours Per Week:_________
Reason For Leaving:

From:

5934 Fleming Rd

07/14
______

Mo/ Yr

Mo/Yr

1
0
Total ____Yrs.
________Mo.
Hours Per Week:_________
40
Reason For Leaving:

(209) 600-8138

_________________________________________________
Supervisors Name:
Josh Perry
_____________________________________________________

_________________________________________________

$160 total
Title__________________________Last
Salary: _____________
Babysitter/House Keeper

_________________________________________________

Duties:

_________________________________________________

Watch three children, and take care/clean house

and take care of animals.

_________________________________________________

To:

06/14
______

Perry Truck Repair

Babysitter

Atwater, CA.

(209) 345-6789

_________________________________________________
_________________________________________________
Supervisors Name:
Darlene Dover
________________________________________________

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.

Josh Perry

Complete Address (Include City, State, Zip)

5934 Fleming Rd.

Phone

Occupation_______

(209)600-8138
Truck Repair

Atwater, CA. 95301

________________________________________________________________________________________________________________________________
2. Dede

McNally

123 Angel Ct.

(209) 233- 6444

AT&T manager

Atwater, CA. 95301

________________________________________________________________________________________________________________________________
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:_________________________________________________________________