Job Application
Job Application
(Last)
(First)
05/09/14
____________________
(Middle)
Date
345 R Street
Present mailing address:___________________________________________________________
(City)
(209 ) 723-4928
(Telephone Number)
(State)
(Zip Code)
[email protected]
658-5466
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)
Spanish
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:________________________________
Yes
_______________________
(Number)
RECORD OF EDUCATION
Name of School
High School
City/State
Course of
study or
major
Merced/CA
College/
University
Last year
completed
Did you
graduate?
Diploma
or degree
1 2 3 4
yes
diploma
1 2 3 4
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
FULL TIME
AVAILABILITY
PART TIME
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
5pm-10pm
5pm-10pm
5pm-10pm
5pm-10pm
5pm-10pm
5pm-10pm
10am-10pm
_________________________________________________
Duties
_________________________________________________
N/A
_________________________________________________
To:
______
______
Mo / Yr
Mo/Yr
From:
_________________________________________________
Supervisors Name:
_____________________________________________________
_________________________________________________
_________________________________________________
Duties:
_________________________________________________
N/A
_________________________________________________
To:
______
______
Mo/ Yr
Mo/Yr
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
_________________________________________________
Duties:
_________________________________________________
N/A
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
James Barnes
Phone
Occupation_______
(209)228-8585
Associate Director
________________________________________________________________________________________________________________________________
2. Jorge
Aguayo
Math Teacher
________________________________________________________________________________________________________________________________
3. Steve
Eccles
Science teacher
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________