ROP APPLICATION

Directions: Please Print Legibly

Carrillo
Jazmeen
Name: __________________________________________

(Last)

(First)

4/28/15
____________________

(Middle)

Date

186 Westmont Ct
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95348
_______________________________________________________________________________

(City)

(209 ) 626-9600

(State)

(Telephone Number)

(Zip Code)

jazmeenabarca@yahoo.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Position applied for:_______________________________________________________________

Internship
Skills and/or competencies which qualify you for this position:
I am a respectful and selfless students who is always caring for others and would like to learn more about
human behavior and how we can help others solve their problems. I have been a part time worker at a local
restaurant where our goal is to treat our "customers" as guests and make them feel wlecome.
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
High School

College/
University

City/State

Merced High School

Merced, CA

Merced College

Merced, CA

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

General

1 2 3 4

Yes

Diploma

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Youth Opportunity Program, CAL-SOAP, Young Life, Aquatics Club, Swimming, Water Polo

FULL TIME

AVAILABILITY
SUNDAY

ALL DAY

MONDAY

TUESDAY

4-CL

WEDNESDAY

PART TIME

THURSDAY

FRIDAY

SATURDAY

4-CL

4-CL

ALL DAY

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

Period of Employment
From:

Company Name, Address, and Phone Number

$9.00
Cashier
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Working Counter, Cashier, Interacting with

customers, Taking orders and reading them back.

_________________________________________________

To:

4/2014
______

______

Mo / Yr

Mo/Yr

1
Total ____Yrs.
________Mo.
25
Hours Per Week:_________
Reason For Leaving:

From:

Job Title and Duties Performed

Sizzler Restaurant

1334 W Olive Ave, Merced, CA

(209)723-7100

_________________________________________________
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.

Rebbecca LIncoln

Complete Address (Include City, State, Zip)

632 W 13th Street, Merced, CA

Phone

Occupation_______

(209)381-5992
Career Educator

________________________________________________________________________________________________________________________________
2. Mike

1334 W Olive Ave, Merced, CA

(209)723-7100
General Manager

________________________________________________________________________________________________________________________________
3. Kae

1334 W Olive Ave, Merced, CA

(209)723-7100
Store Manager

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________