State Fire Marshal Application
Section 1: Personal Information
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1.1 Title: Miss
1.2 First Name: Lydia
1.3 Last Name: Juarez
1.4 Middle Name: D.N.A
1.5 Date of Birth: 08/AUG/1995
1.6 Weight: 120 lbs
1.7 Height 5 ft 6 ins
1.8 Primary place of residence: 2005 San Andreas Blvd - Floor 5, Room 2
1.9 Contact Number: 36505724
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:
- General Education Diploma (Duration - (2001-2013) 12 Years) - Liberty City Public High
Bachelor of Science in Mechanical Engineering (Duration - (2013-2017) 4 Years ) - University of Michigan
Master of Science in Mechanical Engineering (Duration - (2017-2019) 2 Years) - University of Michigan
Section 3: Employment History
Please list below your entire employment history, including your most recent agency service.
3.1 Most recent agency affiliation: Auto Exotic Garage
3.2 Rank held: Mechanic
3.3 Tenure: 00 years, 1/2 months (16/NOV/2023 - CURRENT)
3.4 Please list any further affiliations or employment hereunder, including position and tenure:
- Diamond Casino & Resort - Security (Part-Time) - Tenure: 24/NOV/2023 - CURRENT
Dynasty Nightlife - Security (Part-Time) - Tenure: 16/NOV/2023 - CURRENT
Urban Vehicle Restoration Garage, Liberty City - Assistant Engineer - Tenure - 09/AUG/2020 to 02/NOV/2022
- Urban Vehicle Restoration Garage, Liberty City - Had to move due to personal reasons.
Auto Exotic Garage - Will switch to Part Time if employed.
Diamond Casino & Resort & Dynasty Nightlife - Will resign after employment.
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.
- D.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:
- Purchase Firearm License (PF)
San Andreas Guard Card (GC)
Section 6: Declaration
Replace and complete as appropriate the information hereunder:
Name (print): Lydia JuarezOn submitting this application, I, Lydia Juarez, 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):
Date: 01/DEC/2023
(( Section 7: OOC Information ))
7.1 Forum name: Loke
7.2 Geographical location and timezone: India and UTC +5:30
7.4 Discord username: DeadManLoke#8290
7.5 Please list languages in which you may be fluent in, alongside English: English, Tamil.
7.6 How long have you been roleplaying on GTA:W, and roleplaying in total? GTA World - Half a Year On and Off across 3 years, to Roleplay - Solid 8 years.
7.7 List ALL current and past character names. Include faction and rank if applicable.
- Viktor Melikov -> Lincoln Miller -> Lydia Juarez (Diamond Casino and Resort - Security) -> Christina Maynard
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: * Lydia Juarez provides a sample of all of their fingerprints to the Office of the State Fire Marshal at their Rockford Hills HQ on 01/DEC/2023.
7.12 Drug test: * Lydia Juarez conducts a drug test at the SFM Rockford Hills Headquarters on 01/DEC/2023. It returns negative.
