ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Chavez Rafael Ulises ____________________
April 27, 2017
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

188 west circle ave
(P.O. Box or Street Number)

Merced Ca 95348
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 123-4567 ( 209 )____________________

765-4321 ____________________________
123@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Electrical Engineering

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

I've taken several rigorous math classes with grades of B or better such as algebra, geometry, trigonometry
and pre-calculus

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 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

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

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: _________________________________________________

Supervisors Name: _________________________________________________

_____________________________________________________

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:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Maxwell 1045 West 25th street 209-385-6840
Zoo supervisor
________________________________________________________________________________________________________________________________

2. Erica 209-012-1234
Youth leader
________________________________________________________________________________________________________________________________

3.

________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________

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