State Fire Marshal Application
Section 1: Personal Information
1.1: Title (Delete as appropriate): Miss(please specify)
1.2: Forename(s): Makenzie
1.3: Surname(s): Keller
1.4: Other name(s):
1.5: Date of Birth: 12/MAY/1992
1.6: Weight: 144lbs
1.7: Height 5 ft 4 ins
1.8: Primary place of residence: 28 Fantastic PL- Floor 1 room 8
1.9: Contact Number: 8722
1.10: Email Address: [email protected]
Section 2: Educational History
Please list and elaborate on, in the space hereunder, the entirety of your formal education history, including details of qualifications:
Paleto bay high school - Graduated
Section 3: Employment History
Please list below your entire employment history, including your most recent agency service. (( Tenure and agency affiliation must be OOC ))
3.1: Most recent agency affiliation (Delete as appropriate): LSFD
3.2: Rank held: Firefighter 3/Paramedic
3.3: Tenure: 0 years, 4 months (19/DEC/2020- Current)
3.4: Please list any further affiliations or employment hereunder, including position and tenure:
Los Santos Fire department- Engineer/Paramedic - 6 years. ((Above is what I'm currently in on my LSFD character and this is what I'm RPing for my SFM character backstory))
3.5: Please list hereunder reasons for dismissal within previous employment:
Left to focus on raising my child but now looking to get back into a somewhat similar line of work.
Section 4: Medical History
Please list and elaborate on, in the space hereunder, any medical conditions you may have. In addition, please elaborate on any sections of your medical record which may hinder your ability to conduct your duties.
N/A
Section 5: Licensing, Permits and Legalities
5.1: Are you in possession of a valid Driver's License? (Delete as appropriate) Yes
5.2: Are you a lawful citizen of the State of San Andreas? (Delete as appropriate) Yes
5.3: Please list hereunder any other licenses or permits you are in possession of:
N/A
Section 6: Declaration
Replace and complete as appropriate the information hereunder:
On submitting this application, I, Makenzie Keller, understand and confirm that all questions herein were responded to with truthfulness and integrity. I give my permission for the recruitment team to investigate, and to clarify, the information given, for the purpose of validation of this application. I acknowledge the fact that any plagiarism, perjury, or alteration of the contents within this document will result in the application being rejected, and a life-long ban from future applications to the Office of the State Fire Marshal.
Name (print): Makenzie Keller
Name (signed): M.Keller
Date: 18/04/2021
(( Section 7: OOC Information ))
7.1: Forum name: Ezrya
7.2: Age: 19
7.3: Geographical location and timezone (Regardless of DST observance): UK, BST
7.4: Character ID: 42195
7.5: Discord username (Optional): ellie'#0478
7.6: Please list languages in which you may be fluent in, alongside English: N/A
7.7: How long have you been roleplaying on GTA:W, and roleplaying in total? 1 year for GTA:W and 5 years roleplaying in general.
7.8: Please provide an unedited screenshot of your entire admin record: https://imgur.com/1KWkdLH
7.9: Please provide an unedited screenshot of your character statistics summary: https://imgur.com/fJukdA3
7.10: Fingerprint sample: * Makenzie Keller provides a sample of all of their fingerprints to the Office of the State Fire Marshal at their Vespucci HQ on 18/04/2021.
7.11: Drug test: * Makenzie Keller conducts a drug test at the Vespucci HQ on 18/04/2021. It returns Negtive.
