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ROP APPLICATION
Directions: Please Print Legibly
Salinas
Samuel
Noah
Name: __________________________________________

(Last)

(First)

April 10, 2016

____________________

(Middle)

Date

1934 Shadowbrook Drive, Apt. 1

Present mailing address:___________________________________________________________

(P.O. Box or Street Number)

California
95340
Merced
_______________________________________________________________________________

(City)

(State)

( 209 ) 261-3410

(Zip Code)

salinassamuel4@gmail.com
N/A
(
)____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Crew Member
Position applied for:_______________________________________________________________

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

Communication skills, ability to work in a fast pace, follow company rules

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

N/A
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

Name of School

City/State

Course of
study or
major

Merced High School

Merced,
California

General
Education

College/
University

N/A

Other
(Specify)

N/A

Last year
completed
1 2 3 4

Did you
graduate?

Diploma
or degree

Pending
2016

Pending
2016

1 2 3 4

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Marketing, Peer Assistant Learner

FULL TIME

AVAILABILITY
SUNDAY

Open - 10pm

MONDAY

4 - 10

TUESDAY

4- 10

WEDNESDAY

4 -10

THURSDAY

4 -10

FRIDAY

4 - Close

PART TIME

SATURDAY

Open - Close

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
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

Title__________________________Last
Salary: _____________
N/A

_________________________________________________

Duties:

_________________________________________________

To:

______

______

Mo/ Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

Reason For Leaving:

_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________

From:

To:

______

______

Mo /Yr

Mo/Yr

N/A
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.

Lisa Escobedo

Complete Address (Include City, State, Zip)

205 W. Olive Ave

Phone

209-325-1000

Occupation_______

ROP Teacher

Merced, CA 95340

________________________________________________________________________________________________________________________________
2. Candi

Mucci

205 W. Olive Ave

209-325-1000
Special Ed Teacher

Merced, CA 95340

________________________________________________________________________________________________________________________________
3.

Luke Marvulli

205 W. Olive Ave

209-325-1000

Merced, CA 95340

Math 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:_________________________________________________________________

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

Revised 7/10