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ROP APPLICATION
Directions: Please Print Legibly
Contreras
Karina
Name: __________________________________________

(Last)

(First)

February 7, 2016
____________________

(Middle)

Date

1408 East Olive Avenue

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
95340
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 761-3962

(Telephone Number)

(Zip Code)

contreraskarina737@gmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

Physical Therapist
Position applied for:_______________________________________________________________

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

I am able to give health care instructions, operate medical diagnostic equipment, plan health care
treatments, and I would be a great member of a health service team. I have the skills and abilities to
observe and communicate well with the patients. I am able to tolerate physically taxing workloads and am
able to function effectively under stress.

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

Spanish
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

_______________________
F7485361

(Number)

RECORD OF EDUCATION
Course of
study or
major

Name of School

City/State

Merced High School

Merced, CA

College/
University

High
School
Diploma

Merced College

Merced, CA

Kinesiology

Other
(Specify)

CSU Long Beach

Long Beach, CA

Master's
Degree

High School

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

Yes

Diploma

Yes

Degree

Yes

Degree

List appropriate extracurricular activities, clubs, organizations and courses for this position:
I have been involved in FFA for the last two years of High School. During this, I was able to develop
communication and work skills. I was able to put on organizations and have been chairman. I work well with
others and adapt quickly to new situations. FFA helped me shape into who I am and it helped me prepare for
FULL
my future. I was also in DECA for a year and through this organization, it was able to help prepare for
life TIME
after
high school. Besides the clubs and community
service, I obtained a job since I was 15 years old. Having
job
AVAILABILITY
PARTaTIME
and having to be independent truly shaped me into a mature and independent person. I am able to work
SUNDAY under any
MONDAY
TUESDAY
WEDNESDAY
SATURDAY
efficiently
circumstances
and I know how
to stay positiveTHURSDAY
and make others FRIDAY
happy.

8 hours

8hours

8hours

8hours

8hours

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

$200
Trevino's Mexican RestaurantSalary: _____________
Title__________________________Last

_________________________________________________

Duties

_________________________________________________

Waitressing, taking orders, taking out plates,

serving drinks and using the cash register. I am on
my feet all day serving others to make sure our
customersName:
and satisfied with the food and our
Supervisors
service.
Alejandro Trevino
_____________________________________________________

_________________________________________________

Title__________________________Last Salary: _____________

_________________________________________________

Duties:

_________________________________________________

To:

May/2014
______

May/2020
______

Mo / Yr

Mo/Yr

7
83.9
Total ____Yrs.
________Mo.

20-30
Hours Per Week:_________
Reason For Leaving:

From:

Trevino's Mexican Restaurant, (209)723-5610

_________________________________________________
_________________________________________________

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.

Alejandro Trevino

Complete Address (Include City, State, Zip)

408 W Main St, Merced, CA 95340

Phone

(209)723-5610

Occupation_______

Boss of the Restaurant

________________________________________________________________________________________________________________________________
2. Dawn

Garrett

205 W Olive Ave, Merced, CA 95348

(209) 385-6465

Teacher at Merced High S

________________________________________________________________________________________________________________________________
3.

(209)385-6465

Kassie Mua

205 W Olive Ave, Merced, CA 95348

Teacher at Merced High S

________________________________________________________________________________________________________________________________

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