PREFERRED DEPARTMENT
- [X] Emergency Medicine
- [] Internal Medicine
- [] Surgery
- [] Psychiatric
1. PERSONAL INFORMATION
- 1.1) Title: (select one)
- [] Mr.
- [] Mrs.
- [X] Ms.
- [] Mx.
- [] Other
Kailey
1.3) Middle Name: (optional)
1.4) Last Name:
Kligerman
1.5) Gender: (select one)- [] Male
- [X] Female
- [] Other
SEP/16/1991
1.7) Place Of Birth:
Maple Grove, Minnesota, USA.
1.8) Address:- 1.8.1) Street Name & Number:
1068 Meteor Street Apartments Floor 3 Room 8
1.8.2) City:
Los Santos
1.8.3) State:
San Andreas
- [X] Caucasian
- [] Black or African American
- [] American Indian or Alaska Native
- [] Asian
- [] Pacific Islander or Native Hawaiian
- [] Hispanic or Latino
- [X] Single
- [] Married
- [] Divorced
- [] Separated
- [] Windowed
- [] Civil Partner
5'6
1.12) Weight:
125
1.13) Phone Number:
530-46-47
1.14) Email:
[email protected]
2. EDUCATION BACKGROUND
- 2.1) School Leaving and Higher Education Credentials:
- [] High School Diploma
- [] Certificate (Sub-bachelor or vocational)
- [] Diploma (Sub-bachelor or vocational)
- [] Associate Degree
- [X] Bachelor's Degree
- [] First Professional Degree
- [] Post-bachelor's Diploma/Certificate
- [] Master's Degree
- [] Certificate of Advanced Study
- [] Education Specialist Degree
- [] Doctorate
- 2.2.1) School Name:
St. Cloud State University
2.2.2) Enrollment Term:
08/SEP/2012 to 28/JUN/2016]
2.2.3) Major Course of Study:
Medical Studies
2.3) Are you able to communicate proficiently in the English language?- [X] Yes
- [] No
2.4) Additional Languages:- [] Spanish
- [] Portuguese
- [] Russian
- [] German
- [] Korean
- [] Arabic
- [] Japanese
- [] Dutch
- [] Persian
- [] French
- [] Italian
- [] Chinese
- [] Other: (list them here)
4. MEDICAL INFORMATION
- 4.1) Do you have any diagnosed physical or mental health condition that could hinder your ability to perform your work duties?
- [] Yes
- [X] No
- 4.1.1) If so, state what physical or mental health condition you have:
ANSWER
- [X] Yes
- [] No
- 4.3) Are you currently taking any prescription drugs or medications that could hamper your work performance?
- [] Yes
- [X] No
- 4.3.1) If so, state what prescription drugs or medications you are taking:
ANSWER
- 4.4) Do you have any known allergies?
- [] Yes
- [X] No
- 4.4.1) If so, state what allergies you have:
ANSWER
5. LICENSES AND CERTIFICATES
- 5.1) Do you have a valid San Andreas Driving License?
- [X] Yes
- [] No
- 5.2) Do you have a valid Aviation License?
- [] Yes
- [X] No
- 5.3) Do you have a valid PF or CCW License?:
- [] Yes
- [X] No
- 5.4) Do you have a valid medical certificate from an accredited school or institution?:
- [X] Yes
- [] No
5.4.1) If so, state your certificate(s), school/institution and year of certification(s):
First Aid / Medical Treatment - St. Cloud - 2014
6. MOTIVATIONAL LETTER
- 6.1) Submit your motivational letter down below, describing why you wish to join us, why we should choose you rather than someone else and why the qualities required from this job correspond to you: (max. 800 words)
Back in Minnesota, I missed an important opportunity to experience what it would truly be like in the medical field. Now, I'm fully committed and motivated to have a profound impact as a nurse in Los Santos. My experiences in college have fully prepared me for this moment and I know I'm ready to prove it.
7. RELEASE AND WAIVER
- 7.1) In exchange for the consideration of my job application by Pillbox Hill Medical Center, I agree that:
- Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Pillbox Hill Medical Center practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Pillbox Hill Medical Center, or otherwise to change in any respect the employment at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument. Both the undersigned and Pillbox Hill Medical Center may end the employment relationship at any time, without specified notice or reason. If employed, I understand that Pillbox Hill Medical Center may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
- I, Kailey Kligerman, authorize investigation of all statements contained in this application, including a thorough criminal background check which shall be requested by Pillbox Hill Medical Center to the Los Santos Police Department throughout the handling of the application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice, or denial during the application stage. I hereby give Pillbox Hill Medical Center permission to contact schools, previous employers, references, and others, and hereby release Pillbox Hill Medical Center from any liability as a result of such.
- I, Kailey Kligerman also understand that (1) Pillbox Hill Medical Center has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I, [write your full name here], further understand that continued employment may be based on the successful passing of job-related physical and mental health examinations, should the employer require the applicant to undergo them.
Kailey Kligerman
7.3) Date:
MARCH/23/2022
(( 8. OUT OF CHARACTER INFORMATION ))
- 8.1) User Control Panel Username:
Naryu
8.2) Unedited Screenshot of User Control Panel Administrative Record:
https://i.imgur.com/ry9QvOP.png
8.3) GTA World Forum Account Name:
Naryu
- 8.3.1) Link: https://forum.gta.world/en/profile/62682-naryu/
East
8.5) When did start playing on GTA World:
2022
8.6) How long has it been since you began roleplaying?:
5 years ago.
8.7) Double Faction Permission: (provide proof below)
N/A
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