Professional Documents
Culture Documents
Name: __________________________________________
Chavez Rafael Ulises ____________________
April 27, 2017
(Last) (First) (Middle) Date
Merced Ca 95348
_______________________________________________________________________________
(City) (State) (Zip Code)
Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?
No Yes If yes, explain:________________________________
RECORD OF EDUCATION
Course of
study or Last year Did you Diploma
Name of School City/State major completed graduate? or degree
High School Merced High School Merced, Ca General Ed 1 2 3 4 Yes Diploma
College/ 1 2 3 4
Fresno State Fresno, Ca Electrical No Hopefully
University
Engineering Degree
Other
1 2 3 4
(Specify)
List appropriate extracurricular activities, clubs, organizations and courses for this position:
FULL TIME
AVAILABILITY PART TIME
7am to 5pm 7am to 4pm 7am to 5pm 7am to 4pm 7am to 6pm
RECORD OF EMPLOYMENT: (Begin with your most recent job)
Period of Employment Job Title and Duties Performed Company Name, Address, and Phone Number
From: To:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo / Yr Mo/Yr
Duties _________________________________________________
Total ____Yrs. ________Mo.
_________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________
From: To:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo/ Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From: To:
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
2. Erica 209-012-1234
Youth leader
________________________________________________________________________________________________________________________________
3.
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________
N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf Revised 7/10