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ROP APPLICATION
Directions: Please Print Legibly
Quezada
Daniela
G.
Name: __________________________________________

(Last)

(First)

4-11-15
____________________

(Middle)

Date

3210 Loughborough Dr.

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

CA
95348
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 769-0823

(Zip Code)

qdaniela98@gmail.com
385-3958
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Vet Clinic Assistant

Position applied for:_______________________________________________________________

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

Positive Attitude, Creativity, Responsible, Volunteering at zoo

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

_______________________
(Number)

RECORD OF EDUCATION
Course of
study or
major

Name of School

City/State

Merced High School

Merced/ CA

General
Education

College/
University

N/A

N/A

N/A

Other
(Specify)

N/A

N/A

N/A

High School

Last year
completed
1 2 3 4

1 2 3 4

1 2 3 4

Did you
graduate?

Diploma
or degree

Pending
June 2016

General

N/A

N/A

N/A

N/A

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Key Club, Farmers Market, M.E.Ch.A, Courthouse Museum, Applegate Zoo, and Rivera Middle School
ASSESTS
FULL TIME

AVAILABILITY
SUNDAY

N/A

MONDAY

3-5:30

TUESDAY

3-5:30

WEDNESDAY

3-5:30

THURSDAY

3-5:30

FRIDAY

3-5:30

PART TIME

SATURDAY

3-5:30

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

Period of Employment
From:

Company Name, Address, and Phone Number

Volunteer
Applegate Zoo
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

feeding animals, cleaning their cages, making their

food

_________________________________________________

To:

2015
______

Current
______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

6
Hours Per Week:_________
Reason For Leaving:

From:

Job Title and Duties Performed

1045 W. 25th Street

Current
______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

Hours Per Week:_________
10
Reason For Leaving:

Merced, CA 95340
(209) 385-6840

_________________________________________________
Supervisors Name:
Donna McDowell
_____________________________________________________

_________________________________________________

Volunteer
Title__________________________Last
Salary: _____________
Rivera Middle School ASSETS

_________________________________________________

Duties:

_________________________________________________

helping them with homework, cleaning, watching

them at activites

_________________________________________________

To:

2015
______

Applegate Zoo

Rivera Middle School ASSETS

945 Buena Vista Dr.

Merced, CA 95348
(209) 385-6680

_________________________________________________
_________________________________________________
Supervisors Name:
Maggie
________________________________________________

From:

To:

2015
______

Current
______

Mo /Yr

Mo/Yr

6
Total ____Yrs. ________Mo.

Key Club

Volunteer
Key Club
Title___________________________Last
Salary: ____________

_________________________________________________

Duties:

_________________________________________________

Helps out others, farmer market,

_________________________________________________

205 W Olive Ave

1
Hours Per Week:_________
Reason For Leaving:

Merced, CA 95348
(209) 261-4427

_________________________________________________

Supervisors Name:
Secretary: Geffry Flores
________________________________________________

_________________________________________________

REFERENCES: Give the names of three persons not related to you.

Name
1.

Tammie Meyer

Complete Address (Include City, State, Zip)

205 W. Olive Ave

Phone

(209) 756-8901

Occupation_______

Child Development

Merced, CA 95348

________________________________________________________________________________________________________________________________
2. Andrea

DeLeon

205 W. Olive Ave

(209) 777-2496
ELD/ English 2

Merced, CA 95348

________________________________________________________________________________________________________________________________
3.

Maggie

945 Buena Vista Dr.

(209) 261-4032

Merced, CA 95348

ASSETS Director

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________
4/18/2016

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

Revised 7/10