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Print 3
Name: __________________________________________
Orozco Daniel ____________________
4-26-17
(Last) (First) (Middle) Date
Merced CA 95340
_______________________________________________________________________________
(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 Highschool Merced CA 1 2 3 4 Pending
College/ 1 2 3 4
University
Other
1 2 3 4
(Specify)
List appropriate extracurricular activities, clubs, organizations and courses for this position:
FULL TIME
AVAILABILITY PART TIME
10:00am-10:00 pm
10:00 am - 10:0010:00
pm am - 10:00 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:
service clerk 10.50 hour Smart and final CO
4/17
______ still emplyed Title__________________________Last Salary: _____________
______
_________________________________________________
Mo / Yr Mo/Yr
Duties _________________________________________________
Total ____Yrs. ________Mo.
stock food and carts, help out cashiers. _________________________________________________
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.
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3.
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________
N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf Revised 7/10