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DEPARTMENT OF CORRECTIONS OFFICE OF PEACE OFFICER SELECTION AND EMPLOYEE DEVELOPMENT COVER SHEET |
PERSONAL HISTORY STATEMENT
SADCR 1902 (Rev. 06/19)
PERSONAL HISTORY STATEMENT
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A. PERSONAL INFORMATION
- A1. First Name: Wendell
A2. Middle Name: N/A
A3. Last Name: Haney
A4. Date of Birth: 10/04/2003
A5. Place of Birth: Los Santos, SA
A6. Gender: [X] Male [-] Female
A7. Ethnicity: [-] Caucasian [X] African American [-] Hispanic [-] Middle Eastern [-] Asian [-] Other
A8. Physical Description:- Height: 5' 9''
Weight: 152 lbs
Hair Color: Black
Eye Color: Brown
A10. Contact Number: 2594204
A11. Contact Email: [email protected]
A12. Citizenship: [X] U.S. Citizen [-] Naturalized citizen [-] Legal alien [-] U.S. citizenship applicant [-] None of the above
A13. Languages spoken: [X] English [X] Spanish [-] Japanese [-] Chinese [-] Russian [-] Korean [-] Vietnamese [-] Arabic [-] Other: Specify - Height: 5' 9''
B. LICENSE INFORMATION
- B1. Licenses possessed: [X] Driver's License [-] License to Purchase a Firearm (PF License) [-] License to Carry a Concealed Weapon (CCW License)
B2. Have any of the above licenses ever been suspended and/or revoked? [-] Yes [X] No
B3. If yes, please explain: N/A
C. EDUCATION
- List your level of education and any educational institution you have attended in the forms below, including high schools, colleges, and universities. If more space is required, attach additional forms as necessary.
C1. Check the boxes if you meet the requirements: [-] General Education Diploma [X] High School Diploma [-] Associate's Degree [-] Bachelor's Degree [-] Master's Degree [-] Doctorate
C2. List of High School(s) attended:- Name of High School: Los Santos High School
Address: 2228, Guantanamo Avenue, Los Santos
Highest Grade Completed: A
- Name of College/University: N/A
Address: N/A
Type of Degree: N/A
Major / Area of Study: N/A
- Name of High School: Los Santos High School
D. EXPERIENCE AND EMPLOYMENT
- D1. Employment History: List all previous employment you have had in the forms below, including self-employment, part-time and full-time jobs, temporary and volunteer work and internships. If more space is required, attach additional forms as necessary.
- Company Name: Reebok
Job Title / Rank: Warehouse packer
Reason for leaving: I was just stagnating in this job, I needed a good and steady paycheck and a career.
D3. If yes, please explain: N/A
D4. Military Service: List your military experience, including service branch, military occupational specialty (MOS) code and type of discharge received upon separation from the armed forces. If more space is required, attach additional forms as necessary.- Have you served in the United States Armed Forces?: [-] Yes [X] No
Branch: Army / Marines / Navy / Air Force / Coast Guard
Military Occupational Specialty Code: N/A
Type of Discharge: N/A
- Have you served in a law enforcement agency? [-] Yes [X] No
Name of agency: N/A
Rank / Position: N/A
Reason for leaving: N/A
- Company Name: Reebok
E. CERTIFICATION
- I certify that all the information provided by me in connection with my application, whether on this document or not, is true and complete, and I understand that any misstatement, falsification, or omission of information may be grounds for refusal to hire or if hired, termination of employment.
I understand that as a condition of employment, I will be required to provide legal proof of authorization to work in the U.S.
I understand that SADCR will check with law enforcement agencies for any criminal history in accordance with applicable statutes.
I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such parties from all liability from any damages which may result from furnishing such information to you.
This application for employment shall be considered active for a period of time not to exceed 14 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
APPLICANT NAME: Wendell Haney
APPLICANT SIGNATURE: Wendell Haney
DATE: 1/24/2003
(( F. OOC INFORMATION ))
- F1. Timezone: GMT +3
F2. Screenshot of the in-game statistics (/stats) of the character you are applying with: ACCESS
F3. List of all current characters and past character names, current levels and name of current faction:
Spoiler: showF4. List and link of all current and past LSRP forums accounts:Spoiler: showF5. List and link of screenshots of admin records for all characters:Spoiler: showF6. Have you ever been banned from a legal faction? [-] Yes [X] NoSpoiler: show
F7. If yes, fill the form below: N/AF8. Do you have a microphone? [-] Yes [X] NoSpoiler: show
F9. Do you have TeamSpeak 3 and are you prepared to use it? [X] Yes [-] No
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