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[divbox=white][hr][/hr][center][img]https://i.imgur.com/YNwKrcn.png?1[/img]

STATE OF SAN ANDREAS
LICENSE TO PRACTICE MEDICINE APPLICATION FORM[/center]



[hr][/hr]
[list=none][b][center]SECTION ONE - PERSONAL INFORMATION[/center][/b][/list][hr][/hr]
[list=none]
[b]1. TITLE:[/b] MS
[b]2. FULL NAME:[/b] Charlotte Watson

[b]3. DATE OF BIRTH:[/B] 5/15/1981
[b]4. PLACE OF BIRTH:[/b] Santa Flora, San Fierro.
[b]5. AGE AT TIME OF APPLICATION:[/b] 37

[b]6. PHONE NUMBER:[/b] 555-1589
[b]7. E-MAIL ADDRESS:[/b] CharlotteWatson81@lsmail.com
[b]8. DOMESTIC ADDRESS:[/b] 1178 Mildred Avenue, Marina, Los Santos, 313 San Andreas

[/list]
[hr][/hr]
[list=none][b][center]SECTION TWO - PERSONAL HISTORY[/center][/b][/list][hr][/hr]
[list=none]

[b]9. HAVE YOU EVER GONE BY ANOTHER NAME? IF YES, LIST ALL THAT ARE APPLICABLE BELOW:[/b]
[list=1][*] N/A[/list]

[b]10. HAVE YOU EVER BEEN CONVICTED OF BREACHING ANY OF THE SAN ANDREAS LAW OR THAT OF ANOTHER COUNTRY?: IF YES, EXPLAIN IN THOROUGH DETAIL:[/b]
[list=1][*] N/A[/list]

[b]11. LIST ALL AND ANY EDUCATION THAT YOU HAVE ENROLLED IN. ADD MORE FIELDS IF NEEDED:[/b]
[list=none][b]NAME OF HIGH SCHOOL:[/b] Hashbury High School
[b]YEAR GRADUATED:[/b] 1999
[b]DEGREE(S) EARNED:[/b] High School Diploma

[b]NAME OF COLLEGE:[/b] San Fierro Medical Center
[b]YEAR GRADUATED[/b]: 2002
[b]DEGREE(S) EARNED: Bachelors Degree[/b]

[b]TYPE OF MEDICAL DOCTOR: M.D Medical Doctor
[b]MCAT SCORE (COMPLEX-USA SCORE IF D.O):508[/b]
[b]RESIDENCY LOCATION: San Fierro Medical Center[/b]
[b]SPECIALIZATION:Family Medicine[/b]
[b]AFFILIATIONS AND OR BOARD CERTIFICATIONS:American Board Of Family medicine[/b]

[b]NAME OF UNIVERSITY:[/b] Los Santos University
[b]YEAR GRADUATED:[/b] 2012
[b]DEGREE(S) EARNED:[/b] Medical Doctorate[/list]

[b]12. LIST ALL AND ANY PREVIOUS EMPLOYMENT. ADD MORE FIELDS IF NEEDED:[/b]
[list=none][b]NAME OF EMPLOYER:[/b] Burgershot
[b]PLACE OF EMPLOYMENT:[/b] Burgershot
[b]OFFICIAL COMPANY TITLE:[/b] Burgershot
[b]JOB DESCRIPTION:[/b] Cashier
[b]DATE EMPLOYED:[/b] 1/12/1997
[b]DATE DISCHARGED:[/b] 5/16/2000
[b]REASON OF DISCHARGE:[/b] Resignation

[list=none][b]NAME OF EMPLOYER:[/b] Victim Clothing
[b]PLACE OF EMPLOYMENT:[/b] Victim Clothing
[b]OFFICIAL COMPANY TITLE:[/b] Victim Clothing
[b]JOB DESCRIPTION:[/b] Cashier/Store Manager
[b]DATE EMPLOYED:[/b] 6/2/2000
[b]DATE DISCHARGED:[/b] 4/20/2005
[b]REASON OF DISCHARGE:[/b] Resignation

[list=none][b]NAME OF EMPLOYER:[/b] Subway
[b]PLACE OF EMPLOYMENT:[/b] Subway
[b]OFFICIAL COMPANY TITLE:[/b] Subway
[b]JOB DESCRIPTION:[/b] Cashier
[b]DATE EMPLOYED:[/b]4/26/2005
[b]DATE DISCHARGED:[/b] 12/05/2006
[b]REASON OF DISCHARGE:[/b] Resignation

[list=none][b]NAME OF EMPLOYER:[/b] San Andreas Department Of Motor Vehicles
[b]PLACE OF EMPLOYMENT:[/b] San Andreas Department Of Motor Vehicles
[b]OFFICIAL COMPANY TITLE:[/b] San Andreas Department Of Motor Vehicles
[b]JOB DESCRIPTION:[/b] Road Test examiner.
[b]DATE EMPLOYED:[/b] 1/02/2007
[b]DATE DISCHARGED:[/b] 1/26/2013
[b]REASON OF DISCHARGE:[/b] Resignation

[list=none][b]NAME OF EMPLOYER:[/b] Fort Carson Medical Center
[b]PLACE OF EMPLOYMENT:[/b] Fort Carson Medical Center
[b]OFFICIAL COMPANY TITLE:[/b] Fort Carson Medical Center
[b]JOB DESCRIPTION:[/b] Residency - Family Medicine Physician
[b]DATE EMPLOYED:[/b] 2/15/2013
[b]DATE DISCHARGED:[/b] 8/23/2018
[b]REASON OF DISCHARGE:[/b] Resignation
[/list]

[/list]
[hr][/hr]
[list=none][b][center]SECTION THREE - LICENSING BASED QUESTIONS[/center][/b][/list][hr][/hr]
[list=none]

[b]13. WHAT SORT OF PRACTICE/PROFESSION ARE YOU AIMING TO PURSUE IF LICENSED?:[/b]
[list=none]
[X] NURSING
[ ] DOCTOR[/list]

[b]14. HAVE YOU EVER BEEN TRAINED IN BASIC LIFE SUPPORT AND/OR INTERMEDIATE LIFE SUPPORT?:[/b]
[list=none][Y] YES (WHO WAS THIS PROVIDED BY?: San Fierro Medical Center)
[ ] NO[/list]

[b]15. PLEASE EXPLAIN IN FURTHER DETAIL WHY YOU WISH TO ACQUIRE A LICENSE TO PRACTICE MEDICINE:[/b]
[list=none]Well, I've worked in this field before and I just moved back into Los Santos after a hiatus. This is my passion, I love to help people
I don't think I would be happier doing anything else if I'm being honest. It's something I enjoy doing, I wouldn't pass it up for a million dollars
the feeling you get when you help people is a great feeling that can't be replaced. If I recieve this, I plan on applying at the Los Santos County
Clinic since I've heard wonderful things about it.[/list]

[/list]
[hr][/hr]
[list=none][b][center]SECTION FOUR - DECLARATION[/center][/b][/list][hr][/hr]
[list=none][quote][justify]I, Charlotte Watson, hereby declare that all of the information stated within this application is true and is as accurate to my knowledge as possible. I accept that, should I be found to have lied regarding any information, I am subject to immediate disciplinary action without question. I also affirm that I understand that, should my license be accepted, I am required to learn and follow acts up to and regarding the Hippocratic Oath. This declaration also serves as a confirmation that I have filled in all aforementioned details on my own and not by another.[/justify]

DATE: 09/08/2018
SIGNATURE: Charlotte Watson[/quote][/list][/divbox]