[4] Jeremiah Chamberlain [PASSED #20]
Posted: Tue Nov 18, 2025 9:57 am
SECTION 1: PERSONAL INFORMATION
- Full Name:
- Jeremiah Chamberlain
- Date of Birth:
- 16/10/2000
- Sex: Pilih salah satu
- Male
- Age:
- 25
- Birthplace:
- Birmingham
- Race/Ethnic Category: Pilih salah satu
- Caucasian
- Height:
- 185
- Weight:
- 70
- Address:
- Los Collinas
- Phone Number:
- 6345634
- Do you have a valid Certificate Medical Record? (CMR)
- No
- Do you have a valid Certificate of Good Conduct Section? (CGC)
- Yes
Link Jeremiah Chamberlain
- Yes
SECTION 2: EDUCATION AND EMPLOYMENT
- Latest Education:Pilih salah satu
- Graduate Degree
- List all high schools, colleges, and universities attended:
- Name of School:
- San Fiero Central High School
- Location:
- San Fiero
- Name of University:
- San Fierro University
- Location:
- San Fiero
- Major/Area of study:
- Law And Crime Justice
- Name of School:
- Job experience:
- Name of Employer:
- Trucker Restock Company
- Job title/Rank:
- Worker Driver
- Name of Employer:
- If you have served in the military, please indicate which branch: Pilih salah satu
- Never
SECTION 3: LICENSES INFORMATION
1. Do you possess a valid (unexpired) driving license?..................YES
2. Do you possess a valid (unexpired) firearms license?..................NO
3. Do you possess a valid (unexpired) flying license?...................NO
4. Do you possess a valid (unexpired) sailing license?...................NO
5. Have your licenses ever been revoked by Law Enforcement?No
SECTION 4: LEGALITY INFORMATION
- Have you ever been detained by law enforcement, arrested, indicted, charged, or convicted of any misdemeanor or felony offense in this state or any other legal jurisdiction?
- No
Kosongkan jika No
- No
- Have you ever used or experimented with any currently illegal drugs?
- No
Kosongkan jika No
- No
- Has your work performance ever been affected by your use of alcohol or drugs?
- No
SECTION 5: CERTIFICATION
- I hereby certify that I have personally completed and initialed each page of this form and any attached supplemental page(s), and that all statements made are true and complete to the best of my knowledge and belief. I understand that any misstatement of material fact may subject me to disqualification; or, if I have been appointed, may disqualify me from continued employment.
Signature: JEREMIAH CHAMBERLAIN
(( SECTION 6: OUT OF CHARACTER ))
- Full Name:
- Anugrah Putra
- Age:
- 17
- Current Timezone:
- WITA
- UCP Account:
- ShadowNight
- Device:
- Android
- Character List:
- Jeremiah Chamberlain (27)
- Do you have a valid Character Story?
- Yes
Link: Jeremiah Chamberlain
- Yes
- How long have you been playing on the server?
- Less Then 6 Months
- Have you ever received a warning, been jailed, or faced a ban as a punishment from the server staff?
- No
- How many warning point do you have?
- 0
- How long have you been roleplaying in SAMP?
- 3Month
- List down all of the server that you have ever played on, including your RP in the server!
- CPRP(civil)LPRP(civil)
- Screenshot /stats:
https://imgur.com/a/qrVPNsA - Do you consent to have a working microphone if you are accepted?
- Yes
- Declaration:
- I am always willing to be an active member of the San Andreas Police Department, at least one month after completing the academy.
- I am willing to inform SAPD members if I encounter any obstacles during my duty.
- I am willing to obey all the rules and regulations.
- I am willing not to take on any additional jobs besides my responsibilities in the SAPD.
- I am willing to accept the consequences of a 120-minute jail time and a fine of $60,000.00 if I violate this contract.
- I hereby swear, in an out-of-character context, that all the information I provided in the Out of Character Section is true. I will treat all San Andreas Police High Command Team members with politeness, regardless of their ages, or other factors. Furthermore, I understand that I can be terminated, kicked, suspended, or even banned from the server for any reason, whether it is in-character or out-of-character.
