[ Field Ride Along Program] Aya Shiro

Moderators: Executive Staff, LSSD Staff Officers, LSSD Command Officers, LSSD Supervisory Officers

Locked
Aya Shiro
Civilian
Posts: 8
Joined: Mon Nov 21, 2022 8:00 pm

[ Field Ride Along Program] Aya Shiro

Post by Aya Shiro »


Image

Los Santos Police Department
Office of Support Services

LSPD Ride Along Application Form

To assist us in reviewing your application, we request that you complete this questionnaire. The information that you provide will be used only for evaluation and suitability checks. Please read each question carefully and mark one response to each question that applies.
1. Personal Information:
  • 1.1 Last Name: Shiro
    1.2 First Name: Aya
    1.3 Middle Name:
  • 1.4 Address: Alta St
    1.5 City: Los Santos
    1.6 State: Andreas
  • 1.7 Current Occupation:
    1.8 Phone Number: 225-165-7481
    1.9 Date Of Birth: 10/01/2004
    1.10 Gender:
    • [-] Male
      [x] Female
      [-] Other
  • 1.11 Ethnic Group / Race (mark only one)
    • [-] Black
      [-] Hispanic
      [x] Asian/Pacific Islander
      [-] Caucasian
      [-] American Indian
      [-] Filipino
      [-] Middle Eastern

2. Criminal & Citation Record:
  • The San Andreas State Police conducts a Criminal Background check on all ride-along applicants. Applicants are also required to inform the San Andreas State Police of any type of Criminal Background or interactions they may have had with the Department. Failure to do so will lead to an immediate denial of the application and possible restrictions on further applications.

    2.1 Please mark one of the following that best applies on the basis of severity:
    • [x] I have a clean Criminal Record.
    • [-] I have received Traffic/Infraction citations from San Andreas Law Enforcement that I have paid or had upheld in Court.
    • [-] I have been arrested by San Andreas Law Enforcement on Misdemeanour charges which I have pled Guilty/No Contest to or have had upheld in Court.
    • [-] I have been arrested by San Andreas Law Enforcement on Felony charges which I have pled Guilty/No Contest to or have had upheld in Court.

3. Release & Waiver:
  • As a condition precedent to being permitted to ride as a Ride-Along Observer in a vehicle or vehicles operated by any officer or person employed by the San Andreas State Police, I the undersigned, waive any claim I may have against the San Andreas State Police and the officers, agents and employees of the Los Santos Police Department and Los Santos Sheriff Department for any loss of life, bodily injury, property damage or any other claim whatsoever that I may sustain as a result of riding as such Ride-Along Observer. I also promise I have read, and I understand all of the Ride-Along regulations. I further agree that this waiver of liability by me is binding on my legal representatives, heirs, and successors, and shall have the same legal effect as I have agreed to herein.

    3.1 Full Name (Signature): Aya Shiro
    3.2 Full Name (Print Name): _Aya Shiro_
    3.3 Date: 21/11/2022

Locked