ROP APPLICATION

Directions: Please Print Legibly

Shabazz
Jaylyn
Cyera
Name: __________________________________________

(Last)

(First)

3 May 2015
____________________

(Middle)

Date

3774 Jardin Way

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
Merced
95341
_______________________________________________________________________________

(City)

(209 ) 723-9706
(Telephone Number)

(State)

(Zip Code)

jcshabazz@gmail.com
631-3422
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

Position applied for:_______________________________________________________________

Floral Designer
Skills and/or competencies which qualify you for this position:
Knowledge of floral design elements.2 years of floral design and art history class. 1 year of fashion design
class. Knowledge of principles of design.

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

College/
University

City/State

Merced High School

Merced, CA

Merced Junior College

Merced, CA

Course of
study or
major

Business
Admin.

Other
(Specify)

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

Yes

Diploma

1 2 3 4

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
FFA Floral Design and Art History class. Fashion and Merchanding class.

FULL TIME

AVAILABILITY
SUNDAY

9AM-6PM

MONDAY

TUESDAY

9AM-6PM

WEDNESDAY

PART TIME

THURSDAY

2PM-9PM

FRIDAY

SATURDAY

9AM-6PM

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.

Ken Cooper

Complete Address (Include City, State, Zip)

3720 Cran Avenue Merced CA, 95348

Phone

Occupation_______

(209)201-1847
Assistant Principal

________________________________________________________________________________________________________________________________
2. Pamela

Simmons

632 West 13th Street Merced CA, 95341

(209)723-8935
Instructor/Teacher

________________________________________________________________________________________________________________________________
3. Mark

Abejuela

205 West Olive Avenue Merced CA, 95340

(209)385-6467
Teacher

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________