ROP APPLICATION

Directions: Please Print Legibly

medel
izaak
Name: __________________________________________

(Last)

(First)

tue april 28
____________________

(Middle)

Date

496 south north avenue

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
merced
95341
_______________________________________________________________________________

(City)

(State)

(209 ) 3858095

(Zip Code)

imedel102276@muhsdstudents.org
N/A
(
)____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Position applied for:_______________________________________________________________

service clerk
Skills and/or competencies which qualify you for this position:
i have previous woirk experience, ive worked with the boys and girls club, theyve teached me about
teamwork, showed me how to deliver good service, ive worked with them for two summers i believe i am
qualified for this position
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

City/State

merced high school

Course of
study or
major

Last year
completed

Did you
graduate?

Diploma
or degree

student

1 2 3 4

N/A

N/A

merced

College/
University

N/A

1 2 3 4

Other
(Specify)

N/A

1 2 3 4

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

FULL TIME

AVAILABILITY
SUNDAY

MONDAY

6am-10pm

6am-10pm

TUESDAY

PART TIME

WEDNESDAY

THURSDAY

6am-10pm

6am-10pm

FRIDAY

SATURDAY

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

Period of Employment
From:

Company Name, Address, and Phone Number

service clerk
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

push carts ,store is clean, clean bathrooms, help

other departments, helping bag

_________________________________________________

To:

june21/2014
______

N/A
______

Mo / Yr

Mo/Yr

1
Total ____Yrs.
________Mo.
22
Hours Per Week:_________
Reason For Leaving:
still employed

From:

Job Title and Duties Performed

209 3852200

_________________________________________________
Supervisors Name:
sergio
_____________________________________________________

_________________________________________________

Title__________________________Last
Salary: _____________
volunteer

_________________________________________________

Duties:

_________________________________________________

help younglings, and help the supervisors

supervise groups of children

_________________________________________________

To:

jun1
______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

Hours Per Week:_________
5-6
Reason For Leaving:

smart and final, martin luther king jr way,

boys and girls club

615 W 15 street merced CA 95340

209 722 9922

_________________________________________________

seasonal

_________________________________________________
Supervisors Name:
julian
________________________________________________

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

Complete Address (Include City, State, Zip)

Phone

Occupation_______

1.

________________________________________________________________________________________________________________________________
2.

________________________________________________________________________________________________________________________________
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:_________________________________________________________________