ROP APPLICATION

Directions: Please Print Legibly

Cosey
Aliyah
Cosey
Name: __________________________________________

(Last)

(First)

4/29/15
____________________

(Middle)

Date

P.O Box 2334

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95340
_______________________________________________________________________________

(City)

(209 ) 201-2338
(Telephone Number)

(State)

(Zip Code)

amcosey820@yahoo.comV
600-1819
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Volunteer Program
Skills and/or competencies which qualify you for this position:
Hard wrorker,fast learner,works well with others

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

City/State

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

Yes

Diploms

Merced High School

Merced CA

N/A

1 2 3 4

Merced College

Merced CA

BIology

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
BSU, Claws volunteer program

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

2pm-8pm

4pm-10pm

4pm-10pm

4pm-10pm

4pm-10pm

4pm-10pm

2pm-8pm

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

N/A
Sales clerk
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Cleaning,greeting customers,Shipment

_________________________________________________

To:

9/14
______

4/15
______

Mo / Yr

Mo/Yr

7
Total ____Yrs. ________Mo.

(209) 726-8716

7
Hours Per Week:_________
Reason For Leaving:
RoP ended

From:

_________________________________________________
Supervisors Name:
Tammy Raigehlo
_____________________________________________________

_________________________________________________

8.00
Title__________________________Last
Salary: _____________
Sales Associate

_________________________________________________

Duties:

_________________________________________________

Opeaning/Closing,Stocking Shelvs,Greeting
Customers

_________________________________________________

To:

4/14
______

6/14
______

Mo/ Yr

Mo/Yr

2
Total ____Yrs. ________Mo.
Hours Per Week:_________
10
Reason For Leaving:

Rainbow 1388 W Olive Ave, Merced, CA 95348

Icings By Clairs 750 Merced Mall, #10 Merced,

CA 95348

_________________________________________________
_________________________________________________
Supervisors Name:
Veronica Hernadaz
________________________________________________

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.

LIsia Escobedo

Complete Address (Include City, State, Zip)

205 West Olive Ave, Merced, CA 95348

Phone

Occupation_______

(209)385-6465
ROP Teacher

________________________________________________________________________________________________________________________________
2. Danise

Weaver

205 W Olive Ave, Merced, CA 95348

(209)385-6465
English Teacher

________________________________________________________________________________________________________________________________
3. Shanitha

Scoggings

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts is cause for dismissal.

Date:_________________________Signature:_________________________________________________________________