ROP APPLICATION

Directions: Please Print Legibly

Hultgren
Gabrielle
Alexa
Name: __________________________________________

(Last)

(First)

2-8-16
____________________

(Middle)

Date

125 south fork ave apartment A

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

california
merced
95341
_______________________________________________________________________________

(City)

(State)

( 209 ) 620-5253

(Zip Code)

lexiiloo7214@gmail.com
417-4797
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Customer Service
Position applied for:_______________________________________________________________

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

Outgoing, Friendly, Time Management, Quick learner, Patient, Clear Communication Skills, Positive
Language, Good emotion reading skills

Languages spoken and/or written (other than English):___________________________________

Not Applicable
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

High School

College/
University

Name of School

City/State

Course of
study or
major

Merced High School

Merced CA

N/A

Not Applicable

Not Applicable

N/A

Other
(Specify)

Last year
completed
1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

not yet

diploma

N/A

Na

1 2 3 4

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

FULL TIME

AVAILABILITY
SUNDAY

12 am-12 pm

MONDAY

4 pm- 9 pm

TUESDAY

4 pm- 9 pm

WEDNESDAY

4 pm- 9 pm

THURSDAY

4 pm- 9 pm

FRIDAY

4 pm- 11 pm

PART TIME

SATURDAY

12 am- 12 pm

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
Child Care
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

Feeding, burping, diaper changing, putting to bed,

entertaining, exercising with the children

_________________________________________________

To:

02/11
______

current
______

Mo / Yr

Mo/Yr

5
60
Total ____Yrs.
________Mo.
35
Hours Per Week:_________
Reason For Leaving:

From:

125 South Fork Ave Apt A

(209) 261-0702

_________________________________________________
Supervisors Name:
Andrea Martinez
_____________________________________________________

_________________________________________________

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.

Andrea Martinez

Complete Address (Include City, State, Zip)

125 South Fork Ave Apt A Merced, CA 95341

Phone

Occupation_______

(209)-261-0702

________________________________________________________________________________________________________________________________
2. Christina

Gil

112 Pyramid ct Merced CA 95340

(209)-205-6385

________________________________________________________________________________________________________________________________
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:_________________________________________________________________

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

Revised 7/10