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 position of San Andreas Peace Officer, in accordance with POST.
- 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. Check applicable boxes with an "X". If a question does not apply to you, write “D.N.A” (does not apply) in the space provided for your response.
- By submitting this form, you affirm that you have read and understood the Essential Job Functions and Selection Requirements of the position applied for.
- (( Preview your application before submitting it to make sure that all the BBCode works properly. If it does not, use the blank application format as a guidance tool to fix it. Try to avoid touching the BBCode and only fill out text answers, and that way it will not break. ))
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.
Page 1 of 5
SECTION 1: PERSONAL INFORMATION
1. YOUR LEGAL NAME
TITLE: MR
FIRST: Curtis
MIDDLE: D.N.A
LAST: Campbell
2. ADDRESS WHERE YOU LIVE
NUMBER / STREET: 131 Princeton Street
CITY: Los Santos
STATE: San Andreas
3. CONTACT NUMBER
19267
4. CITIZENSHIP
[X] U.S. CITIZEN
[—] RESIDENT ALIEN WHO IS ELIGIBLE AND APPLIED FOR U.S. CITIZENSHIP
[—] OTHER
5. IF "OTHER" TO THE ABOVE, DO YOU HAVE YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES?
[X] YES
[—] NO
[—] THIS DOES NOT APPLY TO ME
6. DATE OF BIRTH (DD/MMM/YYYY)
17/MAR/2004
Page 2 of 5
TITLE: MR
FIRST: Curtis
MIDDLE: D.N.A
LAST: Campbell
2. ADDRESS WHERE YOU LIVE
NUMBER / STREET: 131 Princeton Street
CITY: Los Santos
STATE: San Andreas
3. CONTACT NUMBER
19267
4. CITIZENSHIP
[X] U.S. CITIZEN
[—] RESIDENT ALIEN WHO IS ELIGIBLE AND APPLIED FOR U.S. CITIZENSHIP
[—] OTHER
5. IF "OTHER" TO THE ABOVE, DO YOU HAVE YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES?
[X] YES
[—] NO
[—] THIS DOES NOT APPLY TO ME
6. DATE OF BIRTH (DD/MMM/YYYY)
17/MAR/2004
Page 2 of 5
SECTION 2: MOTOR VEHICLE INFORMATION
1. DO YOU HAVE A VALID DRIVER'S LICENSE
[X] YES
[—] NO
2. HAVE YOU RECEIVED ANY TRAFFIC CITATIONS IN THE PAST 3 YEARS?
[—] YES
[X] NO
3. IF "YES" TO THE ABOVE, PLEASE EXPLAIN (INCLUDE WHEN, WHERE AND CIRCUMSTANCES)
D.N.A
Page 3 of 5
[X] YES
[—] NO
2. HAVE YOU RECEIVED ANY TRAFFIC CITATIONS IN THE PAST 3 YEARS?
[—] YES
[X] NO
3. IF "YES" TO THE ABOVE, PLEASE EXPLAIN (INCLUDE WHEN, WHERE AND CIRCUMSTANCES)
D.N.A
Page 3 of 5
SECTION 3: EMPLOYMENT AND EDUCATION
1. WHAT IS YOUR HIGHEST LEVEL OF EDUCATION
[X] HIGH SCHOOL DIPLOMA
[—] G. E. D.
[—] SAN ANDREAS HIGH SCHOOL PROFICIENCY CERTIFICATE
[—] COLLEGE / UNIVERSITY
2. YOUR EMPLOYMENT HISTORY
Company/Agency Name: Cluckin' Bell
Position: Cashier
Duties Summary: Taking and serving customer's orders, managing the cash register and post-closing cleanup duties.
Employment Term: 06/JAN/2021 - 01/JUN/2025
Reason for Leaving: Pursuit of a better career
3. FILL BELOW IF YOU HAVE APPLIED FOR A STATE AGENCY BEFORE, OR BEEN EMPLOYED BY ONE
Date Filed: D.N.A
Agency Name: D.N.A
Result of Examination/Application: D.N.A
Reason: D.N.A
Date Filed: D.N.A
Agency Name: D.N.A
Result of Examination/Application: D.N.A
Reason: D.N.A
4. PLEASE LIST ANY LANGUAGES KNOWN OTHER THAN ENGLISH YOU CAN READ, WRITE, OR SPEAK IN AND NOTATE THE LEVEL ON EACH (READING, WRITING, OR SPEAKING; BASIC, INTERMEDIATE, OR FLUENT)
D.N.A
Page 4 of 5
[X] HIGH SCHOOL DIPLOMA
[—] G. E. D.
[—] SAN ANDREAS HIGH SCHOOL PROFICIENCY CERTIFICATE
[—] COLLEGE / UNIVERSITY
2. YOUR EMPLOYMENT HISTORY
Company/Agency Name: Cluckin' Bell
Position: Cashier
Duties Summary: Taking and serving customer's orders, managing the cash register and post-closing cleanup duties.
Employment Term: 06/JAN/2021 - 01/JUN/2025
Reason for Leaving: Pursuit of a better career
3. FILL BELOW IF YOU HAVE APPLIED FOR A STATE AGENCY BEFORE, OR BEEN EMPLOYED BY ONE
Date Filed: D.N.A
Agency Name: D.N.A
Result of Examination/Application: D.N.A
Reason: D.N.A
Date Filed: D.N.A
Agency Name: D.N.A
Result of Examination/Application: D.N.A
Reason: D.N.A
4. PLEASE LIST ANY LANGUAGES KNOWN OTHER THAN ENGLISH YOU CAN READ, WRITE, OR SPEAK IN AND NOTATE THE LEVEL ON EACH (READING, WRITING, OR SPEAKING; BASIC, INTERMEDIATE, OR FLUENT)
D.N.A
Page 4 of 5
SECTION 4: BACKGROUND CHECK
The County of Los Santos is a Fair Chance employer. Except for a very limited number of positions, you will not be asked to provide information about a conviction history unless you receive a contingent offer of employment. The County will make an individualized assessment of whether your conviction history has a direct or adverse relationship with the specific duties of the job, and consider potential mitigating factors, including, but not limited to, evidence and extent of rehabilitation, recency of the offense(s), and age at the time of the offense(s). If asked to provide information about a conviction history, any convictions or court records that are exempted by a valid court order do not have to be disclosed.
I have read and understand that I will be granted the right to provide an explanation regarding any convictions revealed during my background check.
SIGNATURE: Curtis Campbell
DATE: 19/JUL/2025
Page 5 of 5
I have read and understand that I will be granted the right to provide an explanation regarding any convictions revealed during my background check.
SIGNATURE: Curtis Campbell
DATE: 19/JUL/2025
Page 5 of 5
(( SECTION 5: OUT OF CHARACTER ))
1. WHAT IS YOUR TIME ZONE (GMT)?
GMT+3
2. LS-RP FORUM PROFILE LINK - USE ADDITIONAL LINES FOR ANY ADDITIONAL ACCOUNTS:
3. PROVIDE AN UNEDITED SCREENSHOT OF YOUR LOGIN SCREEN SHOWING ALL CHARACTERS & A SEPARATE UNEDITED (DATE AND TIME DISPLAYED ON TASKBAR) SCREENSHOT OF YOUR ADMIN RECORD (ONE OF YOUR CHARACTERS MUST BE LEVEL 3 - USE ADDITIONAL LINES FOR ANY ADDITIONAL ACCOUNTS):
4. HAVE YOU EVER BEEN BANNED FROM A LEGAL OFFICIAL FACTION?
[—] YES
[X] NO
5. IF "YES" TO THE ABOVE, PLEASE EXPLAIN (INCLUDE WHEN, WHERE AND CIRCUMSTANCES)
D.N.A
6. ARE YOU AN ACTIVE MEMBER OF ANOTHER OFFICIAL FACTION? IF YES STATE THE FACTION AND PROVIDE A PROOF WITH THE DOUBLE FACTION PERMISSION (FOUND HERE)
[—] YES
[X] NO
(Faction name — PERMISSION PROOF)
7. ARE YOU ABLE TO USE TEAMSPEAK WITH A DECENT-QUALITY MICROPHONE?
[X] YES
[—] NO
8. PROVIDE YOUR CHARACTER'S BACKGROUND STORY INCLUDING ALL THE INHERENT INFORMATION, SUCH AS DEVELOPMENT AND TRAITS. DISCUSS THE MOTIVES BEHIND THEIR WISH TO JOIN THE LOS SANTOS COUNTY SHERIFF'S DEPARTMENT (250 WORDS MINIMUM, 800 WORDS MAXIMUM)
NOTE: THE USAGE OF ARTIFICIAL INTELLIGENCE(AI) TOOLS SUCH AS CHATGPT IS STRICTLY PROHIBITED AND WILL RESULT IN AUTOMATIC DISQUALIFICATION OF YOUR APPLICATION.
GMT+3
2. LS-RP FORUM PROFILE LINK - USE ADDITIONAL LINES FOR ANY ADDITIONAL ACCOUNTS:
3. PROVIDE AN UNEDITED SCREENSHOT OF YOUR LOGIN SCREEN SHOWING ALL CHARACTERS & A SEPARATE UNEDITED (DATE AND TIME DISPLAYED ON TASKBAR) SCREENSHOT OF YOUR ADMIN RECORD (ONE OF YOUR CHARACTERS MUST BE LEVEL 3 - USE ADDITIONAL LINES FOR ANY ADDITIONAL ACCOUNTS):
4. HAVE YOU EVER BEEN BANNED FROM A LEGAL OFFICIAL FACTION?
[—] YES
[X] NO
5. IF "YES" TO THE ABOVE, PLEASE EXPLAIN (INCLUDE WHEN, WHERE AND CIRCUMSTANCES)
D.N.A
6. ARE YOU AN ACTIVE MEMBER OF ANOTHER OFFICIAL FACTION? IF YES STATE THE FACTION AND PROVIDE A PROOF WITH THE DOUBLE FACTION PERMISSION (FOUND HERE)
[—] YES
[X] NO
(Faction name — PERMISSION PROOF)
7. ARE YOU ABLE TO USE TEAMSPEAK WITH A DECENT-QUALITY MICROPHONE?
[X] YES
[—] NO
8. PROVIDE YOUR CHARACTER'S BACKGROUND STORY INCLUDING ALL THE INHERENT INFORMATION, SUCH AS DEVELOPMENT AND TRAITS. DISCUSS THE MOTIVES BEHIND THEIR WISH TO JOIN THE LOS SANTOS COUNTY SHERIFF'S DEPARTMENT (250 WORDS MINIMUM, 800 WORDS MAXIMUM)
NOTE: THE USAGE OF ARTIFICIAL INTELLIGENCE(AI) TOOLS SUCH AS CHATGPT IS STRICTLY PROHIBITED AND WILL RESULT IN AUTOMATIC DISQUALIFICATION OF YOUR APPLICATION.
Spoiler: show
