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Rop Job Application With Availability Fillable For Website

Laura Garcia has applied for the position of Occupational Therapist. She has a valid California driver's license and communicates well with others. She speaks Spanish in addition to English. Garcia attended Merced High School in Merced, California and is available to work part time weekday afternoons and weekends. She lists Andrea Deleon, a former teacher, as a reference.

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58 views

Rop Job Application With Availability Fillable For Website

Laura Garcia has applied for the position of Occupational Therapist. She has a valid California driver's license and communicates well with others. She speaks Spanish in addition to English. Garcia attended Merced High School in Merced, California and is available to work part time weekday afternoons and weekends. She lists Andrea Deleon, a former teacher, as a reference.

Uploaded by

api-309673774
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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ROP APPLICATION

Directions: Please Print Legibly


Garcia
Laura
Alejandra
Name: __________________________________________

(Last)

(First)

8 February 2016
____________________

(Middle)

Date

Po Box 1501
Present mailing address:___________________________________________________________

(P.O. Box or Street Number)


CA
Merced
95340
_______________________________________________________________________________

(City)

(State)

( 209 ) 355-8503

(Zip Code)

[email protected]
354-0072
( 209 )____________________
____________________________
(Alternative Telephone Number)
(Email Address)

(Telephone Number)

Occupational Therapist
Position applied for:_______________________________________________________________

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


I communicate well with others and I adjust to my surrounding realy quick and im not afraid of a challenge

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 Drivers License?


No

Yes

_______________________
(Number)

RECORD OF EDUCATION

High School

Name of School

City/State

Merced High School

Merced/CA

Course of
study or
major

College/
University

Last year
completed

Did you
graduate?

Diploma
or degree

1 2 3 4

1 2 3 4

Other
(Specify)

1 2 3 4

List appropriate extracurricular activities, clubs, organizations and courses for this position:

FULL TIME

AVAILABILITY
SUNDAY

MONDAY

TUESDAY

WEDNESDAY

8:00am-6:00pm 4:00pm-7:00pm4:00pm-7:00pm 4:00pm-7:00pm

THURSDAY

FRIDAY

PART TIME

SATURDAY

4:00pm-7:00pm 4:00pm-7:00pm8:00am-6:00pm

RECORD OF EMPLOYMENT: (Begin with your most recent job)


Period of Employment
From:

Job Title and Duties Performed

Company Name, Address, and Phone Number

Title__________________________Last Salary: _____________

_________________________________________________

Duties

_________________________________________________

To:

______

______

Mo / Yr

Mo/Yr

Total ____Yrs. ________Mo.

_________________________________________________
Hours Per Week:_________
Reason For Leaving:

From:

_________________________________________________
Supervisors Name:
_____________________________________________________

_________________________________________________

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.

Andrea Deleon

Complete Address (Include City, State, Zip)

205 W Olive Ave, Merced, CA 95348

Phone

(209)777-2496

Occupation_______

Teacher

________________________________________________________________________________________________________________________________
2.

________________________________________________________________________________________________________________________________
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:_________________________________________________________________

N:\ROP\Charlotte Klock\ROP Forms\Forms\ROP Job Application with availbility back-for fillable.rtf

Revised 7/10

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