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ROP APPLICATION

Directions: Please Print Legibly

Name: __________________________________________
Sano Lindsey Mieko ____________________
April 19, 2018
(Last) (First) (Middle) Date

Present mailing address:___________________________________________________________


1355 Indian Ridge Court
(P.O. Box or Street Number)

Merced CA 95340
_______________________________________________________________________________
(City) (State) (Zip Code)

(209 ) 761 - 2958 ( 209 )____________________


722 - 0697 ____________________________
Lindseysano@gmail.com
(Telephone Number) (Alternative Telephone Number) (Email Address)

Position applied for:_______________________________________________________________


Optometrist

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


Quick learner, Research and critical thinking, communication and leadership, strategic planning, project
management, responsible and reliable, skilled in Microsoft Office, Youth mentor

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:________________________________

Do you possess a valid California Driver’s License?


‰ No ‰ Yes _______________________
Y3717557
(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 No

College/ 1 2 3 4
Merced College Merced, CA No
University

Other
1 2 3 4
(Specify)

List appropriate extracurricular activities, clubs, organizations and courses for this position:
Academic Decathlon
Science Club

FULL TIME
AVAILABILITY PART TIME

SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

X X X X X
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:
Karate Instructor
Title__________________________Last $50
Salary: _____________
Eastwind Martial Arts Academy
_________________________________________________
6/14
______ Current
______
Mo / Yr Mo/Yr
Duties
1635 G St, Merced, CA 95340
_________________________________________________
3
Total ____Yrs. 9
________Mo.
Helping students during classes (209) 723 - 1358
_________________________________________________
10
Hours Per Week:_________ Teach classes (ages 3-15)
Reason For Leaving: _________________________________________________
N/A
Supervisor’s Name: _________________________________________________
Chris Abrescy
_____________________________________________________

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

_________________________________________________
Supervisor’s Name:
________________________________________________

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

_________________________________________________
Supervisor’s Name:
________________________________________________

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


Name Complete Address (Include City, State, Zip) Phone Occupation_______
1.
Chris Abrescy 1635 G St, Merced, CA, 95340 (209) 723 - 1358
Executive Director
________________________________________________________________________________________________________________________________

2. Keith Tetangco 206 W Olive Ave, Merced, CA, 95348 (209) 325 - 1000
Teacher
________________________________________________________________________________________________________________________________

3. Tammie Meyer 206 W Olive Ave, Merced, CA, 95348 (209) 325 - 1000
Teacher
________________________________________________________________________________________________________________________________

I authorize investigation of all statements contained in this application.


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

Date:_________________________Signature:_________________________________________________________________