ROP APPLICATION

Directions: Please Print Legibly

Monteon
Jande
Marliss
Name: __________________________________________

(Last)

(First)

5-11-15
____________________

(Middle)

Date

205 West Olive Ave

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

Ca
Merced
95344
_______________________________________________________________________________

(City)

(State)

(555 ) 555-555
(Telephone Number)

(Zip Code)

jmonteon103650@muhsdstudents.org
555-555
( 555 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Physical Therapist
Skills and/or competencies which qualify you for this position:
Patient, honest, hard workder, team worker, caring and focued

no
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

_______________________
T576764675
(Number)

RECORD OF EDUCATION

Name of School
High School

College/
University

Course of
study or
major

City/State

Merced High School

Merced, Ca

Cal State East Bay

Hayward, ca

Kinesiology

Other
(Specify)

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

yes

diploma

1 2 3 4

no

degree

1 2 3 4

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

FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

PART TIME

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

$500
Dealing with Pigs
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Cleaning pig pens, checking the baby pigs in the

nursery, clipping pigs and selling pigs.

_________________________________________________

To:

12/10
______

7/11
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

5-8
Hours Per Week:_________
Reason For Leaving:
Moved to a different town

From:

12/12
______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

Hours Per Week:_________
8
Reason For Leaving:

559-280-0119

_________________________________________________
Supervisors Name:
Nathan Copp
_____________________________________________________

_________________________________________________

$300
Title__________________________Last
Salary: _____________
Christamas Trees

_________________________________________________

Duties:

_________________________________________________

Assist customers with trees, keep the tree lot clean

and sell christmas trees

_________________________________________________

To:

12/12
______

Power House Farms

Ellison Tree Lot

555-555-555

_________________________________________________

Seasonal

_________________________________________________
Supervisors Name:
Kevin Ellison
________________________________________________

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.

Grace Taylor

Complete Address (Include City, State, Zip)

200 Ward Rd, Los Banos, Ca, 93635

Phone

Occupation_______

555-555-555
V.P

________________________________________________________________________________________________________________________________
2. Hondy

Chrisoulis

200 Ward Rd, Los Banos, Ca, 93635

555-555-555
Office

________________________________________________________________________________________________________________________________
3. Gina

Woitas

200 Ward Rd, Los Banos, Ca, 93635

555-555-555
Office

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________