ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Zuzlewski, Emilie, Nkauj Lia ____________________
05/06/2019
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

1257 Catalina Drive
(P.O. Box or Street Number)

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

(209 ) 446-2787 ( 209 )____________________

724-9540 ____________________________
emilie.zuzlewski@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

substitute teacher for MCOE

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

Extensive experience with public speaking.
Thrive in a team environment and work well with others
Complete tasks in an efficient and reliable manner

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

NA

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 Driver’s 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 Liberal 1 2 3 4 yes diploma
Studies
College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Merced Youth Council, PACIFIC Club, Leadership, Leo Club, LINK Crew.

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

NA after 3 pm after 3pm after 3pm after 3 pm after 3 pm open all day
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:
Busser
Title__________________________Last $12 an hour
Salary: _____________
Taste of Little India
_________________________________________________
Feb. 2019
______ May 2019
______
Mo / Yr Mo/Yr
Duties
1052 W Main St, Merced, CA 95340
_________________________________________________
4
Total ____Yrs. ________Mo.
clean tables, make salads, help put away dishes (209) 722-2230
_________________________________________________
8
Hours Per Week:_________
Reason For Leaving: _________________________________________________
Offered another job
Supervisor’s Name: _________________________________________________
Parm Samra
_____________________________________________________

From: To:
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo/ Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisor’s Name:
________________________________________________

From: To:
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisor’s Name:
________________________________________________

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

Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Lam Kindavong 678 W. 18th Street (209) 492-6789
Rec. Coordinator
Merced, CA, 95348
________________________________________________________________________________________________________________________________

2. Jennifer Arrellano 678 W. 18th Street (209) 689-2894

Rec. Coordinator
Merced, CA, 95348
________________________________________________________________________________________________________________________________

3. Robert Garcia 1238 Panoramo Point (209) 578- 3484

Valley Crisis Supervi
Merced CA, 95348
________________________________________________________________________________________________________________________________

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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