ROP APPLICATION

Directions: Please Print Legibly

Gilliam
Tatum
Rochellle
Name: __________________________________________

(Last)

(First)

05/05/15
____________________

(Middle)

Date

877 Emory Ct.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
Merced
95341
_______________________________________________________________________________

(City)

(209 ) 381-0177
(Telephone Number)

(State)

(Zip Code)

tgilliam102236@muhsdtudents.org
756-8075
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Farm Sales Representative
Skills and/or competencies which qualify you for this position:
Money Managemnet, Customer Serivice, Working With Others, Working Individually, Communications

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

Course of
study or
major

City/State

Merced High School

Merced/ CA

Last year
completed

College
Prep

College/
University

Did you
graduate?

1 2 3 4

Diploma
or degree
Pending
2015

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
FFA, Link Crew, CSF, Early Scholars Program

FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

All Day

4-10

4-10

4-10

4-10

4-10

All Day

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
Floral Student
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

08/11
______

06/15
______

Mo / Yr

Mo/Yr

4
Total ____Yrs.
________Mo.
Hours Per Week:_________
Reason For Leaving:

From:

205 West Olive Ave.

wiring and taping, arrangment construsting, window

display construction, filling orders, customer
services.

06/15
______

Mo/ Yr

Mo/Yr

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

(209) 385-6465

_________________________________________________
_________________________________________________

Supervisors Name:
Amanda Galan, Linda Clinton
_____________________________________________________

_________________________________________________

$20 a day
Title__________________________Last
Salary: _____________
Baby Sitter

_________________________________________________

Duties:

_________________________________________________

Taking care of 2-4 children, preparing meals, keep

children safe and clean, keep house clean.

_________________________________________________

To:

06/13
______

Merced FFA Floral Shop

Amber Gonzalez
(209) 205- 0380

_________________________________________________
_________________________________________________
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.

Keith Chastain

Complete Address (Include City, State, Zip)

760 W. 8th St.

Phone

Occupation_______

(209) 385-6687
Teacher

Merced, CA 95341

________________________________________________________________________________________________________________________________
2. Linda

Clinton

205 W. Olive Ave.

(209) 385-6465
Teacher

Merced, CA 95348

________________________________________________________________________________________________________________________________
3. Amber

Gonzalez

353 Daffodil Dr.

(209) 205-0380

Merced, CA 95341

Health Aid

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________