ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Montero Lizette ____________________
04/26/17
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

880 Groveland Ct
(P.O. Box or Street Number)

Merced CA 95340
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 658-7230 ( 209 )____________________

385-9954 ____________________________
lizette.montero7@yahoo.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Healthcare Administrator Assistant

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

-working quickly
-typing quickly

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 _______________________
1140A236
(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 GED 1 2 3 4 Pending Diploma
2017
College/ 1 2 3 4
n/a
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
FFA, AVID, CSF, Link Crew, Soccer Club, Soccer, Volleyball

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

12-5 12-5 12-5 12-5 12-5 12-5 12-5

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:
Catering
Title__________________________Last $0
Salary: _____________
Delicious Catering
_________________________________________________
07/16
______ Present
______
Mo / Yr Mo/Yr
Duties
1120 D st Merced CA
_________________________________________________
0
Total ____Yrs. 10
________Mo.
-serve food and drinks (209)261-7150
_________________________________________________
6
Hours Per Week:_________
Reason For Leaving: _________________________________________________

Supervisors Name: _________________________________________________

Evelia Ansurez
_____________________________________________________

From: To:
$0 Little Dreamers
Childcare Provider
Title__________________________Last Salary: _____________ _________________________________________________
8/16
______ Present
______
Mo/ Yr Mo/Yr Duties:
880 Groveland Ct Merced CA
_________________________________________________
0
Total ____Yrs. 9
________Mo. -read books (209)201-5956
_________________________________________________
10
Hours Per Week:_________ -teach number, letters etc
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
Katie Widick
________________________________________________

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.
Evelia Ansurez 1120 D st Merced CA 95340 (209)261-7150
Catering
________________________________________________________________________________________________________________________________

2. Katie Widick 1013 Moran Dr Atwater CA 95340 (209)201-5956

Teacher
________________________________________________________________________________________________________________________________

3. Tim Olson 3832 Depaul Ct Merced CA 95340 (209)385-9954

Electronist
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

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

Date:_________________________Signature:_________________________________________________________________