Zoey Brooks

The Department of Health maintains all licensing for all medical services. The Medical Board shall be resposible for the issuance of licenses which is an independent body within the Department of Health. Please review the information contained in this section before proceeding.

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Zoey Brooks
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Joined: August 4th, 2019, 4:17 pm

Zoey Brooks

Post by Zoey Brooks » August 5th, 2019, 2:39 pm


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STATE OF SAN ANDREAS
REQUEST FOR MEDICAL RECIPROCITY


  • SECTION ONE - PERSONAL INFORMATION

  • 1. TITLE: Ms
    2. FULL NAME: Zoey Brooks

    3. DATE OF BIRTH: 04/08/1999
    4. PLACE OF BIRTH: Chicago
    5. AGE AT TIME OF APPLICATION: 20

    6. PHONE NUMBER: 1769389
    7. E-MAIL ADDRESS: [email protected]
    8. DOMESTIC ADDRESS: 1680 Saint Christopher Street, red County, San Andreas, 890

  • SECTION TWO - PERSONAL HISTORY

  • 9. HAVE YOU EVER GONE BY ANOTHER NAME? IF YES, LIST ALL THAT ARE APPLICABLE BELOW:

    No

    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:

    Never

    11. LIST ALL AND ANY EDUCATION THAT YOU HAVE ENROLLED IN. ADD MORE FIELDS IF NEEDED:
    • NAME OF HIGH SCHOOL: Kelvyn Park High School
      YEAR GRADUATED: 2013
      DEGREE(S) EARNED: GED

      NAME OF COLLEGE: University of Illinois at Chicago.
      YEAR GRADUATED: 2016
      DEGREE(S) EARNED: MSM

      NAME OF MEDICAL SCHOOL: Stritch School of Medicine
      YEAR GRADUATED: 2019

      TYPE OF MEDICAL DOCTOR: MEDICAL DOCTOR (M.D.)
      MCAT SCORE (COMPLEX-USA SCORE IF D.O):509
      RESIDENCY LOCATION:
      SPECIALIZATION:
      AFFILIATIONS AND OR BOARD CERTIFICATIONS:

      12. LIST ALL AND ANY PREVIOUS EMPLOYMENT. ADD MORE FIELDS IF NEEDED:
      • NAME OF EMPLOYER: Brahm Dietch
        PLACE OF EMPLOYMENT: DNA
        OFFICIAL COMPANY TITLE: DNA
        JOB DESCRIPTION: Personal Assistant
        DATE EMPLOYED: 04/08/19
        DATE DISCHARGED: 04/08/19
        REASON OF DISCHARGE: Temporary Employment

    • SECTION THREE - LICENSING BASED QUESTIONS

    • 13. WHAT SORT OF PRACTICE/PROFESSION ARE YOU AIMING TO PURSUE IF LICENSED?:
      • [X] NURSING
        [ ] DOCTOR
      14. HAVE YOU EVER BEEN TRAINED IN BASIC LIFE SUPPORT AND/OR INTERMEDIATE LIFE SUPPORT?:
      • [ ] YES (WHO WAS THIS PROVIDED BY?: ANSWER)
        [X] NO
      15. PLEASE EXPLAIN IN FURTHER DETAIL WHY YOU WISH TO ACQUIRE A LICENSE TO PRACTICE MEDICINE:
      • I'm an aspiring Medical Examiner who wishes to pursue a career in the medical field. I plan on becoming a firefighter and/or paramedic. I have recently applied for a position with the Los Santos Fire Department. I believe that with a license to practice medicine it will give me an upper-hand in the career which I plan on pursuing.

    • SECTION FOUR - DECLARATION

    • I, Zoey Brooks, 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.
      DATE: 05/08/2019
      SIGNATURE: Z B Brooks

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