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DEPARTMENT OF MEDICAL EXAMINER-CORONER RIDE ALONG PROGRAM APPLICATION
DEPARTMENT OF MEDICAL EXAMINER-CORONER RIDE ALONG PROGRAM APPLICATION
- Title: Mr.
- First name(s): James
- Last name: Takehiro
Date of Birth: 22/07/1996
Phone number: 360-95-314
Place of Birth: Cedarville, San Andreas, USA
Nationality: American
Residential address: 3 Alta Street, Floor 16, Room 1
What is the reasoning behind your ride along?: I am interested in a job in the department, and I am interested in experiencing what the day-to-day operations of a coroner are. As well, I would like to get a better idea of what I would be doing if I were to join the department.
Personal Statement agreement:
SIGNATURE: James TakehiroI the undersigned aware that the work of the Department of Medical Examiner-Coroner personnel is inherently dangerous and that he/she may be subjected to the risk of death, personal injury, or damage to his/her property by accompanying a member or members of the Department of Medical Examiner-Coroner during the performance of their official duties. The undersigned voluntarily assumes the risk of death, personal injury, and property damage arising from or in any way connected with riding along in an Department of Medical Examiner-Coroner vehicle.
DATE: 26/06/2022BACKGROUND AUTHORIZATION:I understand that a criminal check and a warrant check will be conducted as part of the application process. I hereby authorize law enforcement agency, agencies of the government of the United States of America, and agencies of the State of San Andreas to release to the Department of Medical Examiner-Coroner any and all information which said agencies or any of them have about me, for the limited purpose of aiding the Department of Medical Examiner-Coroner in evaluating my eligibility for participation in the Ride Along Program. This release extends to any and all information which said agencies or any of them may have about me, whether public, personal, or confidential. I understand that I will not receive and am not entitled to know the contents of confidential reports received from these agencies and I further understand that these reports are privileged and confidential. I hereby release, discharge, and agree to hold harmless the agencies, their agents and representatives and any person furnishing such information from any and all liability of every nature and kind arising out of the furnishing and inspecting of such documents, records and other information, and this release shall be binding on my legal representatives, heirs and assigns
SIGNATURE: James Takehiro
DATE: 26/06/2022
