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ROP APPLICATION
Directions: Please Print Legibly
Salcido
Maricela
Name: __________________________________________

(Last)

(First)

April 25, 2016

____________________

(Middle)

Date

Present mailing address:___________________________________________________________

711 W 10th St
(P.O. Box or Street Number)
CA
Merced
95340
_______________________________________________________________________________

(City)

(State)

( 209 ) 486-1627

(Telephone Number)

(Zip Code)

salcidomaricela@rocketmail.com
)____________________ ____________________________

(Alternative Telephone Number)

(Email Address)

IHOP Waitress
Position applied for:_______________________________________________________________

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

I am able to stand on my two feet for long periods of time, to interact with customers and just make them
feel the home-like environment.

Spanish/ English
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

Course of
study or
major

City/State

Merced High

Merced/ CA

College/
University

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

PENDING
2016

Degree

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:
I am currently a member for SGJ a youth group located in Merced, CA where as a member I am required to be
part of alot of activites and organizations like; MOP, Merced Community Clean Up, and Youth conferences.
FULL TIME

AVAILABILITY

PART TIME

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

full

part

part

part

part

part

full

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

Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

9.00/hr
Waiter
Title__________________________Last
Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

Feb/15
______

Current
______

Mo / Yr

Mo/Yr

Merced, CA 95340

1
Total ____Yrs.
________Mo.
_________________________________________________

6 hrs
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
Maria Vefa
_____________________________________________________

_________________________________________________

9.75/hr
Title__________________________Last
Salary: _____________
Worker

_________________________________________________

Duties:

_________________________________________________

To:

Jun/15
______

Aug/15
______

Mo/ Yr

Mo/Yr

Atwater, CA 95341

3
Total ____Yrs. ________Mo.

_________________________________________________

Hours Per Week:_________

40 hrs
Reason For Leaving:

_________________________________________________

School Resumed

_________________________________________________
Supervisors Name:
Rafael Yepez
________________________________________________

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.

Virginia Vega

Complete Address (Include City, State, Zip)

Merced, CA 95340

Phone

Occupation_______

(209) 819-9423

Golden Valley Health Cen

________________________________________________________________________________________________________________________________
2. Ashour

Bukko

4033 S Central Ave, Ceres, CA 95307

(209) 556- 1900

Central Valley High Schoo

________________________________________________________________________________________________________________________________
3.

Andrea DeLeon

205 W Olive Ave, Merced, CA 95348

(209) 385- 6465

Merced High School- Tea

________________________________________________________________________________________________________________________________

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