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 Sky Knight Relief Pilot.
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 Sky Knight Relief Pilot.
- 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
- Thomas
- Adam
- Versace
- Month: 05
Date: 20
Year: 1992
- Cabell Huntington Hospital
- [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: 6
In inches: 2
- In pounds: 205
- [X] Single
[—] Married
[—] Divorced
[—] Widow
[—] Legally Separated
[—] Unknown/Not Applicable
- Street Number & Name: 102 Alta Street
City: Los Santos
State: San Anderas
Zip: Answer 560
- 95461484
PROCEED TO NEXT PAGE
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: Wayne High Schhol
Enrollment Term: 08/20/2006 - 05/28/2010
Course of Study: Criminal Justice
PROCEED TO NEXT PAGE
3. EMPLOYMENT HISTORY
17. FIRST PLACE OF EMPLOYMENT
- Company/Agency Name: Walmart
Position: Sales Assiocate
Duties Summary: Assisting customers with their needs, stocking/zoning merchandise
Employment Term: 06/01/2010 - 03/10/2020
Reason for Leaving: Wasn't satisfied with my career trajectory
- Company/Agency Name: Los Santos Fire Department
Position: Firefighter/EMT II, Deputy Commander of Air Operations
Duties Summary: Assisting citizens of San Andreas with their medical needs. Training newcoming pilots, medevacing individuals who met the criteria, also managing the structure of the Air Operations division and making sure it was operating to its fullest potential.
Employment Term: 03/15/2020 - 06/22/2023
Reason for Leaving: In service injury
PROCEED TO NEXT PAGE
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] 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
- Answer Here
- [—] Yes
[X] No
[—] Unknown
[—] Not Willing to Answer
[—] Other
- [—] Yes, I currently serve
- I currently serve in the: Answer Here
- I have formerly served in the: Answer Here
[—] 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
PROCEED TO NEXT PAGE
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.
31. SIGNATURE
31. SIGNATURE
- T. Versace
- Month: 02
Date: 26
Year: 2024
PROCEED TO NEXT PAGE
(( 6. OUT OF CHARACTER QUESTIONS ))
33. MY TIMEZONE
- EST
- DonDon
- [—] Yes
- Elaboration: Answer Here
- [X] Yes
[—] No
- [X] Yes
[—] No
- SPOILER: show
STOP — END OF APPLICATION