Application Title: [Medical Unit Application] Surname, Firstname
Application Format:

---

1.01) Full Name: ANSWER
1.02) Gender:  ANSWER
1.03) Date of Birth:  ANSWER
1.04) Current Age:  ANSWER
1.05) Phone Number:  ANSWER
1.06) Do you have any medical conditions, mental or physical disabilities? If yes, list them here:  ANSWER
1.07) State your current address of residence: ANSWER

2.01) Birthplace: ANSWER
2.02) Are you a legal US citizen: ANSWER
2.03) If not, do you have a valid passport or visa: ANSWER
2.04) Are you able to speak and write English properly?: ANSWER
2.05) Nationality:  ANSWER
2.06) Do you speak any other languages aside English? If yes, please list them here and your skill level in that language: ANSWER

3.01) Do you possess a valid driving license?: ANSWER
3.02) Has your license ever been revoked? If yes, when and why?: ANSWER
3.03) Have you ever been arrested or charged with a crime?: ANSWER
3.04) Have you ever received a ticket, and if yes for what?: ANSWER

4.01) Tell us about your self and why you wish to join the Blueberry Prison Medical Unit (min. 200 words):

4.02) What makes you different from other applicants that may want the same position (min. 75 words):

5.01) Have you ever submitted an application to the Medical  Unit before? If yes, when?: ANSWER
5.02) Please list any and all previous employments that you have been involved with: ANSWER
5.03) Please list any references from friends or previous employers: ANSWER
5.04) Have you ever served with a other government agency? if yes, which?: ANSWER
5.05) What was your reason for discharging from the agency?: ANSWER

6.01) First Name: ANSWER
6.02) Gender: ANSWER
6.03) Age: ANSWER
6.04) Geographical Location & Timezone: ANSWER
6.05) Time playing BP-RP: ANSWER
6.06) List ALL current and past character names and levels: ANSWER
7.07) List ALL past faction memberships and your rank within those factions: ANSWER
7.08) Link a screenshot of your in-game statistics (accessed via /stats): ANSWER
7.09) Can you communicate effectively and efficiently in the English language?:  ANSWER
7.10) What motivates you to join the Blueberry Prison Medical Unit? (min.75words): ANSWER

I, Firstname Lastname, hereby consent that any and all information pertaining to a Criminal Record registered in my name with the National Repository for Criminal Records in the United States may be provided to authorized persons at the Blueberry Prison Medical Unit. I recognize that an employee of the Blueberry Prison Medical Unit is in a position of trust within the community and I hereby consent to the Blueberry Prison Medical Unit performing a background check of my criminal records. I further agree to absolutely release, discharge and absolve the Blueberry Prison Medical Unit, the City of Los Santos and its employees from all claims, losses, or damages including indirect or consequential, occasioned by me during, or as a result of any investigation for a Criminal Record.

I, Firstname Lastname, hereby authorize any person, employer, organization, or physician to provide any information, opinion, reports, records, documents or copies thereof in any form, which may be requested in connection with my application for employment with the Blueberry Prison Medical Unit and any subsequent training. Personal information about me will be used to assess my qualifications and suitability in relation to my application as a police officer as well as research purposes. I consent to the collection, use, disclosure, transmittal, and examination of all information compiled by the Blueberry Prison Medical Unit. I agree to waive any right of action against any person or organization providing information or opinions in compliance with this authorization. I hereby acknowledge and declare the terms of this authorization for release of information are fully understood by me.

7.01) Applicant's Signature: ANSWER
7.02) Date: MM/DD/YYYY


------------------------------------------------------------------------
[b]Application Title:[/b] [Application] Firstname Lastname
[b]Application Format:[/b]

[center][img]http://i.imgur.com/olA0Iv4.png[/img][/center]
[hr]

[center][i][b]APPLICANT'S INFORMATION[/b][/i][/center]
[u]1.01)[/u] [b]Full Name:[/b] [i]ANSWER[/i]
[u]1.02)[/u] [b]Gender:[/b]  [i]ANSWER[/i]
[u]1.03)[/u] [b]Date of Birth:[/b]  [i]ANSWER[/i]
[u]1.04)[/u] [b]Current Age:[/b]  [i]ANSWER[/i]
[u]1.05)[/u] [b]Phone Number:[/b]  [i]ANSWER[/i]
[u]1.06)[/u] [b]Do you have any medical conditions, mental or physical disabilities? If yes, list them here:[/b]  [i]ANSWER[/i]
[u]1.07)[/u] [b]State your current address of residence:[/b] [i]ANSWER[/i]

[u]2.01)[/u] [b]Birthplace:[/b] [i]ANSWER[/i]
[u]2.02)[/u] [b]Are you a legal US citizen:[/b] [i]ANSWER[/i]
[u]2.03)[/u] [b]If not, do you have a valid passport or visa:[/b] [i]ANSWER[/i]
[u]2.04)[/u] [b]Are you able to speak and write English properly?:[/b] [i]ANSWER[/i]
[u]2.05)[/u] [b]Nationality:[/b]  [i]ANSWER[/i]
[u]2.06)[/u] [b]Do you speak any other languages aside English? If yes, please list them here and your skill level in that language:[/b] [i]ANSWER[/i]

[center][b][i]CRIMINAL RECORD[/i][/b][/center]
[u]3.01)[/u] [b]Do you possess a valid driving license?:[/b] [i]ANSWER[/i]
[u]3.02)[/u] [b]Has your license ever been revoked? If yes, when and why?:[/b] [i]ANSWER[/i]
[u]3.03)[/u] [b]Have you ever been arrested or charged with a crime?:[/b] [i]ANSWER[/i]
[u]3.04)[/u] [b]Have you ever received a ticket, and if yes for what?:[/b] [i]ANSWER[/i]

[center][b][i]NARRATIVE INFORMATION[/i][/b][/center]
[u]4.01)[/u] [b]Tell us about your self and why you wish to join the Blueberry Prison Medical Unit (min. 200 words):[/b]

[u]4.02)[/u] [b]What makes you different from other applicants that may want the same position (min. 75 words):[/b]

[center][i][b]ADDITIONAL INFORMATION[/b][/i][/center]
[u]5.01)[/u] [b]Have you ever submitted an application to the Medical Unit before? If yes, when?:[/b] [i]ANSWER[/i]
[u]5.02)[/u] [b]Please list any and all previous employments that you have been involved with:[/b] [i]ANSWER[/i]
[u]5.03)[/u] [b]Please list any references from friends or previous employers:[/b] [i]ANSWER[/i]
[u]5.04)[/u] [b]Have you ever served with a other government agency? if yes, which?:[/b] [i]ANSWER[/i]
[u]5.05)[/u] [b]What was your reason for discharging from the agency?:[/b] [i]ANSWER[/i]

[center][i][b]OUT OF CHARACTER[/b][/i][/center]
[u]6.01)[/u] [b]First Name:[/b] [i]ANSWER[/i]
[u]6.02)[/u] [b]Gender:[/b] [i]ANSWER[/i]
[u]6.03)[/u] [b]Geographical Location & Timezone:[/b] [i]ANSWER[/i]
[u]6.04)[/u] [b]Time playing BP-RP:[/b] [i]ANSWER[/i]
[u]6.05)[/u] [b]List ALL current and past character names and levels:[/b] [i]ANSWER[/i]
[u]7.06)[/u] [b]List ALL past faction memberships and your rank within those factions:[/b] [i]ANSWER[/i]
[u]7.07)[/u] [b]Link a screenshot of your in-game statistics (accessed via /stats):[/b] [i]ANSWER[/i]
[u]7.08)[/u] [b]Can you communicate effectively and efficiently in the English language?:[/b]  [i]ANSWER[/i]
[u]7.09)[/u] [b]What motivates you to join the Blueberry Prison Medical Unit? (min.75words):[/b] [i]ANSWER[/i]


[quote]I, Firstname Lastname, hereby consent that any and all information pertaining to a Criminal Record registered in my name with the National Repository for Criminal Records in the United States may be provided to authorized persons at the Blueberry Prison Medical Unit. I recognize that an employee of the Blueberry Prison Medical Unit is in a position of trust within the community and I hereby consent to the Blueberry Prison Medical Unit performing a background check of my criminal records. I further agree to absolutely release, discharge and absolve the Blueberry Prison Medical Unit, the City of Los Santos and its employees from all claims, losses, or damages including indirect or consequential, occasioned by me during, or as a result of any investigation for a Criminal Record.[/quote]

[quote]I, Firstname Lastname, hereby authorize any person, employer, organization, or physician to provide any information, opinion, reports, records, documents or copies thereof in any form, which may be requested in connection with my application for employment with the Blueberry Prison Medical Unit and any subsequent training. Personal information about me will be used to assess my qualifications and suitability in relation to my application as a police officer as well as research purposes. I consent to the collection, use, disclosure, transmittal, and examination of all information compiled by the Blueberry Prison Medical Unit. I agree to waive any right of action against any person or organization providing information or opinions in compliance with this authorization. I hereby acknowledge and declare the terms of this authorization for release of information are fully understood by me.[/quote]

[u]7.01)[/u] [b]Applicant's Signature: [/b] [i]ANSWER[/i]
[u]7.02)[/u] [b]Date:[/b] [i]MM/DD/YYYY[/i]