State Fire Marshal Application
Section 1: Personal Information
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1.1 Title: Mr
1.2 First Name: Sam
1.3 Last Name: -
1.4 Middle Name: Duke
1.5 Date of Birth: 30/03/2000
1.6 Weight: 165 lbs
1.7 Height 6 ft 0 ins
1.8 Primary place of residence: Pink Cage Motel Room 05, Los Santos, San Andreas
1.9 Contact Number: 57444091
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:
- Lone Star High School 2014 - 2018
Texas Tech University 2018 - 2022
Section 3: Employment History
Please list below your entire employment history, including your most recent agency service.
3.1 Most recent agency affiliation: XYZ Tech Solutions
3.2 Rank held: Senior Software Developer
3.3 Tenure: 1 years, 3 months (10/JAN/2022 - 20/APR/2023)
3.4 Please list any further affiliations or employment hereunder, including position and tenure:
- N/A
- Resignation.
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? 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:
- N/A
Section 6: Declaration
Replace and complete as appropriate the information hereunder:
Name (print): Sam DukeOn submitting this application, I, Sam Duke, 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): S. Duke
Date: 19/SEP/2023
(( Section 7: OOC Information ))
7.1 Forum name: JCordoba
7.2 Geographical location and timezone: Indonesia, (GMT) +7
7.4 Discord username: gled_
7.5 Please list languages in which you may be fluent in, alongside English: Indonesia.
7.6 How long have you been roleplaying on GTA:W, and roleplaying in total? 3 years.
7.7 List ALL current and past character names. Include faction and rank if applicable.
- Axel Messier -> Current Character
- Sam Duke -> Current Character
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: * Sam Duke provides a sample of all of their fingerprints to the Office of the State Fire Marshal at their Rockford Hills HQ on 19/SEP/2023.
7.12 Drug test: * Sam Duke conducts a drug test at the SFM Rockford Hills Headquarters on 19/SEP/2023. It returns Negative.
