Você está na página 1de 2

ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Gomez Jacob ____________________
05/01/2017
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________


228 Weiss Ct
(P.O. Box or Street Number)

Atwater California 95301


_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 326-2019 ( )____________________ ____________________________


jacob.j.gomez1530@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________


Legal Intern

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


I am very passionate about law that I am the top of all Government Classes, I excell over my piers in the
hardest adversity. I am very knowledgable about law and politics. It is a second life to me.

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
Course of
study or Last year Did you Diploma
Name of School City/State major completed graduate? or degree
High School Merced High Merced/CA 1 2 3 4

College/ 1 2 3 4
University

Other
1 2 3 4
(Specify)

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

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Evening Noon Noon Noon Noon Noon Evening


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.

________________________________________________________________________________________________________________________________

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