ROP APPLICATION
Directions: Please Print Legibly
Murakami
Sage
Mikio
Name: __________________________________________
(Last)
(First)
06/10/1997
____________________
(Middle)
Date
2217 West Cardella Road
Present mailing address:___________________________________________________________
(P.O. Box or Street Number)
California
Merced
95348
_______________________________________________________________________________
(City)
(State)
(209 ) 777-8645
(Telephone Number)
(Zip Code)
sagemurakami@icloud.com
)____________________ ____________________________
(Alternative Telephone Number)
(Email Address)
Position applied for:_______________________________________________________________
Assistant
Skills and/or competencies which qualify you for this position:
I believe I am qualified for this position becasuse im a great at serving others, I know how to work well with
others and communicate effectively. I have been a part of many teams and know how to handle problems
and situations and get the job done.
Languages spoken and/or written (other than English):___________________________________
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
_______________________
F7083357
(Number)
RECORD OF EDUCATION
Name of School
High School
City/State
Merced High School
Course of
study or
major
Last year
completed
Did you
graduate?
Diploma
or degree
N/A
1 2 3 4
Yes
Diploma
Merced,
California
College/
University
1 2 3 4
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
Merced FFA, Merced FFA Sentinel, Merced Wrestling, Environmental club, Agricultural Leadership
FULL TIME
AVAILABILITY
SUNDAY
PART TIME
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
RECORD OF EMPLOYMENT: (Begin with your most recent job)
Period of Employment
From:
Job Title and Duties Performed
Company Name, Address, and Phone Number
8.50$
Culinary staff
Title__________________________Last
Salary: _____________
_________________________________________________
Duties
_________________________________________________
Handling food and preparing food.
_________________________________________________
To:
06/13
______
08/13
______
Mo / Yr
Mo/Yr
Total ____Yrs. ________Mo.
40
Hours Per Week:_________
Reason For Leaving:
School
From:
Service Systems Associates
_________________________________________________
Supervisors Name:
Rus Murakami
_____________________________________________________
_________________________________________________
Title__________________________Last Salary: _____________
_________________________________________________
Duties:
_________________________________________________
To:
______
______
Mo/ Yr
Mo/Yr
Total ____Yrs. ________Mo.
_________________________________________________
Hours Per Week:_________
Reason For Leaving:
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
Title___________________________Last Salary: ____________
_________________________________________________
Duties:
_________________________________________________
Total ____Yrs. ________Mo.
_________________________________________________
Hours Per Week:_________
Reason For Leaving:
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
REFERENCES: Give the names of three persons not related to you.
Name
1.
Mr. Mua
Complete Address (Include City, State, Zip)
Phone
Occupation_______
205 West Olive Avenue
Teacher
________________________________________________________________________________________________________________________________
2. Mr.
Holland
205 West Olive avenue
Teacher
________________________________________________________________________________________________________________________________
3. Ms.
Clinton
205 West Olive Avenue
Teacher
________________________________________________________________________________________________________________________________
I authorize investigation of all statements contained in this application.
I understand that misrepresentation or omission of facts is cause for dismissal.
Date:_________________________Signature:_________________________________________________________________
