Application
Application
(Last)
(First)
04.01.2015
____________________
(Middle)
Date
(City)
(State)
(813 ) 464.9512
(Zip Code)
[email protected]
720.9762
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)
(Telephone Number)
none
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
Merced High
Course of
study or
major
Last year
completed
Did you
graduate?
Diploma
or degree
ALLA
1 2 3 4
Yes
Diploma
Merced CA
College/
University
1 2 3 4
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
I have sang in a band for three years as well as street performing as a hooper in my spare time while I am not
working, so I am not shy in front of people at all & I love to love & be happy to be around others.
FULL TIME
AVAILABILITY
PART TIME
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
4pm-11pm
3pm-11pm
3pm-11pm
xx
xx
xx
7am-2pm
Server-Host
Title__________________________Last
Salary: _____________
_________________________________________________
Duties
_________________________________________________
_________________________________________________
To:
2013
______
current
______
Mo / Yr
Mo/Yr
From:
_________________________________________________
Supervisors Name:
_____________________________________________________
_________________________________________________
_________________________________________________
Duties:
_________________________________________________
To:
______
______
Mo/ Yr
Mo/Yr
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
_________________________________________________
Duties:
_________________________________________________
_________________________________________________
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
Dustin Ybarra
Phone
Occupation_______
209.631.9961
Manager, Paul's Plac
________________________________________________________________________________________________________________________________
2. Paul
209.769.5008
Ybarra
Giardina
209.505.9500
Salesmen, DiMare &
________________________________________________________________________________________________________________________________
Date:_________________________Signature:_________________________________________________________________