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.
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.
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
- Nikola
- D.N.A
- Plenkovic
- Month: August
Date: 07
Year: 1992
- Croatia
- [X] Male
[—] Female
[—] Other
- [X] White
[—] Black or African American
[—] 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
- In feet: 5'9"
In inches: 69
- In pounds: 176
- [X] Single
[—] Married
[—] Divorced
[—] Widow
[—] Legally Separated
[—] Unknown/Not Applicable
- Street Number & Name: Richman Hotel - Room 611, West Eclipse Blvd.
City: Los Santos
State: San Andreas
Zip: D.N.A
- 06405832
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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
- School Name: Los Santos High School
Enrollment Term: 09/01/2004 to 07/31/2011
Course of Study: High School
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3. EMPLOYMENT HISTORY
16. FIRST PLACE OF EMPLOYMENT
- Company/Agency Name: Downtown Cab Co.
Position: Taxi Driver
Duties Summary: Driving customers to their destinations.
Employment Term: 12/01/2023 to PRESENT
Reason for Leaving: D.N.A
- Company/Agency Name: Senora Logistics
Position: Senior Trucker
Duties Summary: Processing orders by transporting goods and materials between locations.
Employment Term: 12/09/2023 to PRESENT
Reason for Leaving: Answer Here
- Company/Agency Name: Answer Here
Position: Answer Here
Duties Summary: Answer Here
Employment Term: MM/DD/YYYY to MM/DD/YYYY
Reason for Leaving: Answer Here
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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
- [X] Yes
[—] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [X] 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
[—] Other
- D.N.A
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [—] Yes, I currently serve
- I currently serve in the: D.N.A
- I have formerly served in the: D.N.A
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [—] Yes
- Indicate which state(s) and year(s) convicted: Answer Here
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [—] Yes
- Indicate the previous month(s) and year(s) you have used marijuana: MM/YYYY
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [—] 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
30. SIGNATURE
- Nikola Plenkovic
- Month: August
Date: 07
Year: 1992
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(( 6. OUT OF CHARACTER QUESTIONS ))
32. MY TIMEZONE
- UTC +2
- Anubis92
- Trigo
- Anubis92
- D.N.A
- [—] Yes
- Elaboration: Answer Here
- [X] Yes
[—] No
- SPOILER: show
STOP — END OF APPLICATION
