ROP APPLICATION

Directions: Please Print Legibly

Derr
Whitney
A
Name: __________________________________________

(Last)

(First)

01/08/2015
____________________

(Middle)

Date

1179 Quail Court

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95341
_______________________________________________________________________________

(City)

( 209 ) 777-6049

(State)

whitney.derr@yahoo.com
)____________________ ____________________________

(Telephone Number)

(Zip Code)

(Alternative Telephone Number)

(Email Address)

Floral Clerk
Position applied for:_______________________________________________________________

Skills and/or competencies which qualify you for this position:

Work Experience through internship at Merced Floral
Knowledge of the floral industry
Ability to identify over 100 flowers, potted plants, and tools used in the floral industry
Conversational 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

_______________________
F7192637
(Number)

RECORD OF EDUCATION

Name of School
High School

Course of
study or
major

City/State

Merced High School

Merced,
California

General
Education

College/
University

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

NA

NA

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Merced FFA Floriculture Design Team
Internship at Merced Floral
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

Yes

Yes

Yes

Yes

Yes

Yes

Yes

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

$9/hr
Nursery Staff
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

06/11
______

Present
______

Mo / Yr

Mo/Yr

7
3
Total ____Yrs.
________Mo.
20
Hours Per Week:_________
Reason For Leaving:

Still Employed

From:

Gateway Community Church

353 East Donna Drive, Merced, CA 95340

Supervise toddler aged children

Read bible stories
Distribute snacks

(209) 723-4283

_________________________________________________
_________________________________________________

Supervisors Name:
Kendra Singer
_____________________________________________________

_________________________________________________

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.

Kendra Singer

Complete Address (Include City, State, Zip)

353 East Donna Drive, Merced, CA 95340

Phone

Occupation_______

(209) 723-4283 ext.

Children's Director
324

________________________________________________________________________________________________________________________________
2. Joel

Schaap

353 East Donna Drive, Merced, CA 95340

(209) 723-4283 ext.

323
Youth Director

________________________________________________________________________________________________________________________________
3.

Christopher Jensen

3313 G Street Suite B Merced, CA 95340

(209) 381-6880

Merced Co. AOD

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf

Revised 7/10