ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Lopez Medrano Natalia ____________________
05 - 06 - 19
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

9824 Pinehurst Avenue
(P.O. Box or Street Number)

South Gate CA 90280

_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 959 - 8494 ( 323 )____________________

549 - 3959 ____________________________
nlopez105498@muhsdstudents.org
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Tutoring Position

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

I believe I can expand my horizons by applying to this position as it pertains to the career I am pursuing. In
this intership / position I will start off with the abilities I am currently learning in school and will now be able
to apply them to a real life environment .

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 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 1 2 3 4 IP IP

College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
- President Position in Merced Marching 100
- Help younger sister with homework

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

all day 3pm - CL 3pm - CL 3pm - CL 3pm - CL 3pm - CL 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:
Crew Member
Title__________________________Last $12.00 per hour
Salary: _____________
Little Caesar's
_________________________________________________
1-31-19
______ present
______
Mo / Yr Mo/Yr
Duties
63 E 16th St, Merced, CA 95340
_________________________________________________
0
Total ____Yrs. 4
________Mo. 209 723 9599
_________________________________________________
average 30
Hours Per Week:_________
Reason For Leaving: _________________________________________________
In pursuit of a more related
Supervisor’s Name: _________________________________________________
job to my career
Hazel
_____________________________________________________

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.
Alejandro Delgadillo 5200 Lake Rd, Merced, CA 95343
UC Merced Employe
________________________________________________________________________________________________________________________________

2. Hazel 63 E 16th St, Merced, CA 95340

Little Caesar's
________________________________________________________________________________________________________________________________

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:_________________________________________________________________