Instructions to the Applicant
The information you provide in this application will be used in the background investigation to assist in determining your suitability for the non-sworn position of Public Response Dispatcher.
- It is your responsibility to complete this form and provide all required information.
- This document must be filled out electronically and printed.
- You must respond to all items and questions. If a question does not apply to you, write “D.N.A.†(does not apply) in the space provided for your response.
- Send the completed form to your background investigator or the agency to which you are applying.
Disqualification
There are very few
automatic bases for rejection. Even issues of prior misconduct, such as prior illegal drug use, driving under the influence, theft, or even arrest or conviction are usually not, in and of themselves, automatically disqualifying. However,
deliberate misstatements or omissions can and often will result in your application being rejected, regardless of the nature or reason for the misstatements/omissions. In fact, the number one reason individuals “fail†background investigations is because they deliberately withhold or misrepresent job-relevant information from their prospective employer.
BOTTOM LINE: You are responsible for providing complete, accurate, and truthful responses.
1. PERSONAL INFORMATION
1. FIRST NAME
2. MIDDLE NAME
3. LAST NAME
4. DATE OF BIRTH
- Month: 06
Date: 05
Year: 2001
5. PLACE OF BIRTH
6. GENDER
- [X] Male
[—] Female
[—] Other
7. RACE
- [—] White
[—] Black or African American
[X] Hispanic or Latino
[—] American Indian or Alaska Native
[—] Asian
[—] Flippino American
[—] Native Hawaiian or Other Pacific Islander
[—] None of the Above
[—] Two or More Races
8. HEIGHT
9. WEIGHT
10. MARITAL STATUS
- [X] Single
[—] Married
[—] Divorced
[—] Widow
[—] Legally Separated
[—] Unknown/Not Applicable
11. ADDRESS OF PRIMARY RESIDENCY
- Street Number & Name: 1283 Route 68, Motor Motel Room 11
City: Senora
State: San Andreas
Zip: 103923
12. PRIMARY PHONE NUMBER
13. EMAIL ADDREESS
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2. EDUCATION HISTORY
14. LEVEL OF EDUCATION
- [—] Some High School
[X] High School
[—] Some College
[—] Technical College
[—] Associate's Degree
[—] Bachelor's Degree
[—] Master's Degree
[—] Doctorate
15. SCHOOL OF ATTENDANCE
- School Name: Los Santos Highschool
Enrollment Term: 08/20/2015 to 05/15/2019
Course of Study: High-School
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3. EMPLOYMENT HISTORY
16. FIRST PLACE OF EMPLOYMENT
- Company/Agency Name: N/A
Position: N/A
Duties Summary: N/A
Employment Term: N/A
Reason for Leaving: N/A
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4. BACKGROUND QUESTIONAIRE
19. I HAVE A VALID SAN ANDREAS DRIVER LICENSE
- [X] Yes
[—] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
20. I AM LEGALLY ABLE TO WORK IN THE UNITED STATES OF AMERICA
- [X] Yes
[—] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
21. I HEARD ABOUT THIS POSITION THROUGH
- [—] LSSD Website
[—] Sheriff's Station Website
[—] Social Media
[—] College Campus
[—] Career Fair or Seminar
[—] LSSD Employee
[—] LS County Employee
[—] Family Member
[—] Friends or Neighbors
[—] Radio
[—] Billboard
[X] Other
22. IN ADDITION TO ENGLISH, I KNOW THE FOLLOWING LANGUAGE(S)
23. I AM A PERSON WITH A DISABILITY
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
24. I AM A CURRENT OR FORMER MEMBER OF THE UNITED STATES MILITARY
- [—] Yes, I currently serve
- I currently serve in the: Answer Here
[—] Yes, I have formerly served
- I have formerly served in the: Answer Here
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
25. I AM CURRENTLY ON CRIMINAL PROBATION OR PAROLE
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
26. I HAVE PRIOR CONVICTIONS FOR DRIVING UNDER THE INFLUENCE OF ALCOHOL OR OTHER INTOXICANTS IN SAN ANDREAS AND/OR ANOTHER STATE
- [—] Yes
- Indicate which state(s) and year(s) convicted: Answer Here
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
27. I HAVE PREVIOUSLY USED MARIJUANA WITHIN THE LAST YEAR
- [—] Yes
- Indicate the previous month(s) and year(s) you have used marijuana: MM/YYYY
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
28. I HAVE PREVIOUSLY USED OTHER ILLEGAL SUBSTANCES WITHIN THE PAST YEAR
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
29. I HAVE COMMITTED THEFT, OR HAVE EMBEZZLED, AN AMOUNT AT LEAST $950.00
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
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5. DECLARATION & ACKNOWLEDGEMENT
I, the undersigned, do herein agree that the information aforementioned is true and complete to the best of my knowledge under the penalty of perjury. I further agree and understand that the information provided will be utilized by the Los Santos County Sheriff's Department for the purposes of employment & preliminary background investigation for the position of Custody Assistant. I further understand that the Los Santos County Sheriff's Department employs candidates with no regard to race, religion, sexual orientation, creed, ethnicity, veteran status, or disability. I agree that if selected to move forward with the hiring process, I will abide by the hiring standards as prescribed by the Sheriff of Los Santos County and his designated deputies.
30. SIGNATURE
31. DATE
- Month: 11
Date: 03
Year: 2023
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(( 6. OUT OF CHARACTER QUESTIONS ))
32. MY TIMEZONE
33. MY USER CONTROL PANEL USERNAME
34. MY DISCORD NAME
35. MY UNEDITED SCREENSHOT OF MY USER CONTROL PANEL ADMINISTRATIVE RECORD
36. MY GTAWORLD FORUM ACCOUNT
37. MY DOUBLE FACTION PERMISSIONS
38. HAVE YOU EVER BEEN DISCHARGED OR BANNED FROM A LEGAL FACTION? IF SO, ELABORATE
- [X] Yes
- Elaboration: I was discharged from the LSPD in May 2023 for Inactivity. I, however, reinstated in the meantime and am still currently in the faction.
[—] No
39. DO YOU CONSENT TO YOUR CHARACTER ICLY PROVIDING FINGERPRINT SAMPLES AND A MUGSHOT AS PART OF THE APPLICATION PROCESS?
40. ATTACH AN IMAGE OF YOUR CHARACTER FROM THE SHOULDERS UP CLEARLY SHOWING THEIR FACE WITH NOTHING COVERING THE FACE
STOP — END OF APPLICATION
