State Fire Marshal Application
Section 1: Personal Information
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1.1 Title: Miss
1.2 First Name: Minami
1.3 Last Name: Okada
1.4 Middle Name:
1.5 Date of Birth: 06/MAY/1987
1.6 Weight: 120 lbs
1.7 Height 5 ft 6 ins
1.8 Primary place of residence: 2109 Mad Wayne Thunder Drive
1.9 Contact Number: 8437
1.10 Email Address: [email protected]
1.11 Please provide a passport photo (150x150) of you on the right top corner of this form.
Section 2: Educational History
Please list and elaborate on, in the space hereunder, the entirety of your formal education history, including details of qualifications:
- Bachelor of Science in Psychology
Completed at Liberty City University (Duration: 4 years) (1/AUG/2000) (5/SEP/2004)
EMT Certification
Achieved at Liberty City EMS Training Center (Duration: 6 months) (25/SEP/2006) - (24/MAR/2007)
Master of Arts in Clinical Psychology
Attained from Liberty City Grad School of Psychology (Duration: 2 years) (1/JAN/2008) - 15-/JAN/2010)
Certified Mental Health Counselor
Granted by Liberty City Board of Mental Health Professionals (Duration: 1 year)
Section 3: Employment History
Please list below your entire employment history, including your most recent agency service.
3.1 Most recent agency affiliation: Los Santos Fire Department
3.2 Rank held: EMT
3.3 Tenure: 0 years, 6 months (01/APR/2023 - 01/DEC/2023)
3.4 Please list any further affiliations or employment hereunder, including position and tenure:
- FDLC - Psychiatric Emergency Medical Technician (10 years) (5/SEP/2010) - (6/JAN/2021)
Binco - Cashier (2 years) (JAN/2008) - (JAN 2010)
- Resigned because I am interested in another field 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.
- None
Section 5: Licensing, Permits and Legalities
5.1 Are you in possession of a valid Driver's License? Yes
5.2 Are you a lawful citizen of the State of San Andreas? Yes
5.3 Please list hereunder any other licenses or permits you are in possession of:
- PF License
Hunting License
EMT License
Section 6: Declaration
Replace and complete as appropriate the information hereunder:
Name (print): Minami OkadaOn submitting this application, I, Minami Okada , 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 (signed): Minami Okada
Date: 1/DEC/2023
(( Section 7: OOC Information ))
7.1 Forum name: Justin_Kolk
7.2 Geographical location and timezone: CET/CEST
7.4 Discord username: Mozilra
7.5 Please list languages in which you may be fluent in, alongside English:
Dutch
7.6 How long have you been roleplaying on GTA:W, and roleplaying in total?
GTAW for roughly 3 years and SAMP since 2009
7.7 List ALL current and past character names. Include faction and rank if applicable.
- Justine Kolk -> Lynn Sakai (Director of Public Works) -> Minami Okada
- Tim Holland -> Juanito Hernandez
- Penelope Brooks (LSFD EMT) -> Angeline Castillo
7.9 Please provide an unedited screenshot of your character statistics summary: ACCESS
7.10 Please write your character's background story (Minimum 250 words.): 7.11 Fingerprint sample: * Minami Okada provides a sample of all of their fingerprints to the Office of the State Fire Marshal at their Rockford Hills HQ on 1/DEC/1997.
7.12 Drug test: * Minami Okada conducts a drug test at the SFM Rockford Hills Headquarters on 1/DEC/2023. It returns NEGATIVE
