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ROP APPLICATION
Directions: Please Print Legibly
David
Joseph
Name: Duxbury
__________________________________________

(Last)

(First)

May 11, 2015

____________________

(Middle)

Date

3367 Calaveras Ct.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95340
_______________________________________________________________________________

(City)

(209 ) 756-6139
(Telephone Number)

(State)

(Zip Code)

davidlovesfenders@yahoo.com
383-3794
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Reporter/Journalist
Position applied for:_______________________________________________________________

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

I have the ability to communicate well with others, speak in front of large audiences, and record and retain
information quickly. I can also speak Spanish and can get along with anybody at any time.

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

City/State

Course of
study or
major

High School

Last year
completed

Did you
graduate?

Diploma
or degree

Yes

H.S.
Diploma

1 2 3 4

Merced High School

Merced, CA

General Ed.

College/
University

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
SonSeekers Christian Club- prepare messages, speak in front of group or with individuals
Christian Life Center- lead music/speak to large groups
FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

WEDNESDAY

12 p.m-6 p.m.

8 a.m.-8 p.m.

1 p.m.-8 p.m.

12 p.m.- 8 p.m.

PART TIME

THURSDAY

FRIDAY

SATURDAY

8 a.m.-8 p.m. 12 p.m.-8 p.m. 2 p.m.-8 p.m.

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Title__________________________Last Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
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.

Complete Address (Include City, State, Zip)

Phone

Occupation_______

650 East Olive Ave. Merced, CA 95340

Ceasar Johnson

(209) 658-2711

Youth Pastor

________________________________________________________________________________________________________________________________

650 East Olive Ave. Merced, CA 95340

2.

(951) 306-7611

Michael Hull

Senior Pastor

________________________________________________________________________________________________________________________________

760 West 8th Street Merced, CA 95340

3.

Roseanne Johnson

(209) 947-7673

Teacher's Assistant

________________________________________________________________________________________________________________________________

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