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ROP APPLICATION
Directions: Please Print Legibly

Luh Cory Leroy


Name: __________________________________________ 1/21/16
____________________
(Last) (First) (Middle) Date

1153 Loughborough Dr. Apt. 7


Present mailing address:___________________________________________________________
(P.O. Box or Street Number)

Merced California 95348


_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 947-1705 ( N/A


)____________________ coryl727@gmail.com
____________________________
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________


Cashier

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


Math Proficiency, Hospitable, Tech Literate, Can work fast paced

N/A
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 _______________________
(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 College 1 2 3 4 Pending Pending
Merced High School Merced, CA (2017)
Prep (AP) (2017)

College/ 1 2 3 4
University N/A

Other
1 2 3 4
(Specify)
N/A

List appropriate extracurricular activities, clubs, organizations and courses for this position:
R.O.P., Virtual Enterprise

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Open-10PM 4PM-10PM 4PM-10PM 4PM-10PM 4PM-10PM 4PM-Closing Open-Closing


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:
Cashier
Title__________________________Last 10HR
Salary: _____________
Merced High School
_________________________________________________
9/15
______ Present
______
Mo / Yr Mo/Yr
Duties
205 West Olive Ave
_________________________________________________
Total 0 4
____Yrs. ________Mo.
Cashier, Food Prep (209) 385-6465
_________________________________________________
7.5
Hours Per Week:_________
Reason For Leaving: _________________________________________________
Still There
Supervisors Name: _________________________________________________
Lydia
_____________________________________________________

From: To:
N/A
Title__________________________Last Salary: _____________ _________________________________________________
______ ______
Mo/ Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
________________________________________________

From: To:
N/A
Title___________________________Last Salary: ____________ _________________________________________________
______ ______
Mo /Yr Mo/Yr Duties: _________________________________________________
Total ____Yrs. ________Mo. _________________________________________________
Hours Per Week:_________
Reason For Leaving: _________________________________________________

_________________________________________________
Supervisors Name:
________________________________________________

REFERENCES: Give the names of three persons not related to you.


Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
205 West Olive Ave
Lisa Escobedo (209) 385-6465 Teacher
Merced, CA, 95341
________________________________________________________________________________________________________________________________

2. 205 West Olive Ave


Aurora Alamillo (209) 385-6465 Teacher
Merced, CA, 95341
________________________________________________________________________________________________________________________________

3. 205 West Olive Ave


Mark Abejuela (209) 385-6465 Teacher
Merced, CA, 95341
________________________________________________________________________________________________________________________________

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