ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Mazon Carissa Nicole ____________________
4/22/17
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________

3334 Campus Drive
(P.O. Box or Street Number)

Merced CA 95348
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 631-6232 ( 209 )____________________

383-6744 ____________________________
carissa374@aol.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________

Program Aide

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

I have volunteered at this organization for a total of three summers, and I have undergone the training all
three years as well. I have a great understanding of the mission of this establishment, and will make an
excellent contribution in this position.

Languages spoken and/or written (other than English):___________________________________

N/A

Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?
No Yes If yes, explain:________________________________
N/A

Do you possess a valid California Drivers License?

No Yes _______________________
N/A
(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 Merced High School Merced, CA General 1 2 3 4 June 2017 Diploma
Education
College/ 1 2 3 4
N/A N/A N/A N/A N/A
University

Other
N/A N/A N/A 1 2 3 4 N/A N/A
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Volunteer at Boys and Girls Club of Merced County for three summers.

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

7:30-5:30pm 7:30-5:30pm 7:30-5:30pm 7:30-5:30pm 7:30-5:30pm

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

Supervisors Name: _________________________________________________

_____________________________________________________

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

_________________________________________________
Supervisors Name:
________________________________________________

From: To:
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.
Tony Slaton 615 W. 15th Street, Merced, CA 95341 (209)722-9922
Executive Director
________________________________________________________________________________________________________________________________

2. Jennifer Roman 1434 California Street, Atwater, CA 95301 (209)357-6145

Elementary Teacher
________________________________________________________________________________________________________________________________

3. Mike Smith 205 W. Olive Avenue, Merced, CA 95344 (209)600-5910

MM100 Treasurer
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts is cause for dismissal.

Date:_________________________Signature:_________________________________________________________________

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