ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Vang Kalie Houa Chee ____________________
May 12, 2019
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

865 Hanson Ave
(P.O. Box or Street Number)

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

(209 ) 060- 9752 ( )____________________ ____________________________

vangkalie@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Dietry Aide

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

- compassionate - hardworking - skilled in taking vitals
- patient - good communication
- caring - certified in giving CPR

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

N/A

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 _______________________
D01404860
(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 N/A 1 2 3 4 Yes Diploma

College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Medical Technology: We learned how to perform CPR, take vital signs, learn about diseases and health.
Assets Volunteer: I helped students with homework/projects, supervised students, etc.

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

10 AM - 7 PM 10 AM - 7 PM 10 AM - 7 PM 10 AM - 7 PM 10 AM - 7 PM
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:
Student Cashier
Title__________________________Last March 2019
Salary: _____________
Merced High School Cafeteria
_________________________________________________
6/2018
______ 03/2019
______
Mo / Yr Mo/Yr
Duties
205 W Olive Ave, Merced, Ca, 95348
_________________________________________________
0
Total ____Yrs. 9
________Mo.
- cleaning dishes - keeping track of money (209) 325 - 1091
_________________________________________________
3
Hours Per Week:_________ - preparing and serving food
Reason For Leaving: _________________________________________________
Interning at Mercy Cancer
Supervisor’s Name: _________________________________________________
Center.
Sylvia Gracia
_____________________________________________________

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.
Misty Bautista 609 E Alexander Ave (209) 285- 7387
ELP Leader
Merced, Ca, 95340
________________________________________________________________________________________________________________________________

2. Sylvia Gracia 205 W Olive Ave (209) 325-1091

Cafeteria Supervisor
Merced, Ca, 95348
________________________________________________________________________________________________________________________________

3. Samantha Downey 205 W Olive Ave (209) 325 -1000

Science Teacher
Merced W Olive Ave
________________________________________________________________________________________________________________________________

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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