Richard Ambery

Please use blue or black ink when filling out this registration form. Please answer all questions to the best of your ability. For further information or guidance, please contact a member of the Green Ridge town administration team at the number provided in our guide brochure.

Full Name: AMBERY, RICHARD

Age: 46
DOB: 14 November 1964
Gender: Male
Address: Room #17, Motel 6, 1641 East Daily Drive
City: Camarillo
State: California
Ethnicity: Caucasian.
Height: 6'1".
Weight: 180.
Eye Color: Brown
Hair Color: Brown
Distinguishing Marks: I wear glasses. While I did have several tattoos, I have had them removed in the past few years.


Medical History:

Please list any and all allergies and age of onset below:

None

Are you aware of any ongoing medical issues?:

None

Please list any known ongoing medical issues of any dependants under the age of thirteen below. Please note to which dependant each issue belongs:

N/A

If yes, list age of diagnoses by medical professionals, or age of onset below:

N/A

If you are receiving treatment for an ongoing medical complaint, please list prescriptions, strength of dose, frequency of dose, and other treatment plans below:

N/A

Do you smoke tobacco, consume alcohol, or use street drugs? If yes, please list number of packs per day, number of drinks per day and/or names of consumed drugs below:

No. I struggled with alcoholism in the early '90s, but I haven't touched a drop since then.



Green Ridge Residential Registration:

Please list your chosen address within Green Ridge below:

309 Treasure Chest Road

Please list any dependants under the age of thirteen, who reside with you:

None

Please list any dependants over the age of thirteen who reside with you (Be advised that dependants over the age of thirteen must also complete a registration form):

None

Please list any other residents at this address who are not dependants:

None

Please list your marital status. Single/Married/Divorced/Widowed:

Divorced, since 1991.

If married, please provide the name of your spouse if he/she resides with you:

N/A

Please list any large taxable material possessions below, such as motor vehicles or other property of substantial value that will be relocating to Green Ridge Island with you:

None. I don't have anything worth more than a few dollars.

Are you a citizen or a permanent (Green Card) resident of the United States of America?:

Citizen



Employment Registration (Optional):

This section is for those of age sixteen or older who plan to find employment on Green Ridge Island. If you do not meet the criteria, please move to the next section.

Do you plan to find employment on Green Ridge Island? If so, which position(s) are you applying for, and where?:

I plan to apply for the position of Owner, Daisy Bank Farm.

Please list your most recent employment and dates of employment below:

I have been self employed since 1999. I was the owner of a small farm, Ecclesden Farm, here in California. Unfortunately, my finances were not as robust as they should have been, and I was forced to declare bankruptcy approximately three months ago. it was heartbreaking to watch everything I had worked on, every single scrap of my parent's inheritance, all taken from me. With the economy in tatters, I simply couldn't make enough money to cover my costs, let alone turn a profit.

Prior to this, I worked as a farmhand on another farm in the same general area, Roxburry farm. I left this job after I came into some money. My parents died, and their inheritance was enough to allow me to buy a farm of my own. I worked here from 1994 until 1999

I was a member of the US Army from 1982 - 1991. I was dishonourably discharged from my unit, 160th Special Operations Aviation Regiment (Airborne), on charges relating to drunkenness while on duty.

Do you possess any other skills that you feel may benefit your ability to perform in the position(s) for which you are applying? Examples include extra languages, history of customer service and work in the care industries, etc. If yes, please list skills below:

I have been doing the job I am applying for for twelve years. I understand that this farm would be the main source of food for the island community, which would leave me unlikely to lose all of my sales contacts, as I did with my own farm.

As an aside, for the past ten years it has become something of a passion of mine to rescue animals. Horses mostly, but not exclusively. The horses, I would buy from auctions, the kind frequented by kill buyers. Other animals I might get from the same kinds of auctions, or from families who had taken them as pets, or even from other farms which proved incapable of looking after them. I would take the animals in, tend to them, build them up again, and send them off to loving homes. I believe this is the kind of thing you are doing with your patients, turning the broken into useful members of society. This is somethign I am intending to continue to do on your island, alongside the commercial herds of course.

How do you feel your previous employment will benefit your ability to perform in the position(s) for which you are applying?:

I have been doing the same job for twelve years, and similar work for a total of seventeen. I feel this will give me the experience I need to lead the team of farmhands, and to ensure the smooth day to day running of the farm, as well as to ensure that the island will remain well supplied with food.



Education Registration (Optional):

This section is for Green Ridge Island residents under the age of eighteen. All resident under the age of eighteen who do not possess a high school diploma, GED, or reside at St. Christina's Psychiatric Rehabilitation Center are required to complete this education registration. Those who do not meet these criteria, please disregard this section and move to the next.

Please list your highschool grade. Freshman/Sophomore/Junior/Senior:
Answer Here

Please provide the name of your previous highschool below:
Answer Here

What are your academic strengths?:
Answer Here

What are your academic weaknesses?:
Answer Here

What was your previous Grade Point Average?:
Answer Here

Are you interested in extracurricular activities such as sports, art clubs, maths clubs, etc? If yes, explain below:
Answer Here



Legal History:

Be advised that answers to this section will not affect your eligibility for relocation to Green Ridge. The information you provide will not be diverged to third parties.

Do/did you ever abuse controlled substances, including but not limited to prescription medications, street drugs or alcohol? If yes, please explain below:

I abused alcohol. It's hard for me to pinpoint exactly when I went from enjoying a drink to being dependent on it, but I would guess around 1989-1990. I finally got myself cleaned up around 1994, after my release from jail, but by that point, I had already ruined my life.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:

I was dishonourably discharged from the US army after I had been found to have a high blood alcohol content when reporting for duty. This followed a number of lesser alcohol related charges. At the time, I was struggling with the stress of my job, as a pilot in 160th SOAR, I was under constant stress, and i simply could not cope after so long in the unit. I didn't take my discharge well. I am ashamed to admit that I turned my anger on my wife at the time, and our daughter. It started with yelling, but quickly progressed. I hit them. Both of them. My daughter was four years old, and I hit her. In front of her, in a drunken rage, I raped my wife. I have not seen them since, I can only pray they are doing well. I have attempted suicide over these actions. three times, before and during my jail term.

Since my release from prison, I have not touched a drink, nor have I touched a woman. I have not raised my hand to anyone in this time, under any circumstances. These are all things I wish to continue.

If you answered yes to the above, please list sentences connected to these convictions below:

Dereliction of duty, dishonourable discharge.

Four counts of domestic abuse, one count of Spousal rape, Three years in jail. 1991-1994

Have you ever knowingly committed a crime for which you were not convicted or sentenced? If yes, please explain below:

No.



Personal Interview:

Why have you chosen to relocate to Green Ridge Island? Please explain below:

Simply put, I have nowhere else to turn. I am bankrupt, I have a criminal record and a dishonourable discharge, no living family, and no friends. Moving to your island will be my final chance to gain some measure of redemption, if such a thing is even possible after what I did.

Green Ridge Island houses a psychiatric rehabilitation hospital, and as such, living and working amongst those with mental health issues would be typical practice. Are you comfortable with this?:

Yes.

Do you agree to abide by all Green Ridge Island laws and regulations upon relocation?:

Yes.


Resident Signature:

By opting to relocate to Green Ridge Island and the town of Green Ridge, you hereby agree to abide by all Green Ridge Island laws and the instructions of Green Ridge Security, Green Ridge Town Officials, and St. Christina Facility administrators. You hereby waive rights granted to you by the state of Oregon or any other state belonging to the United States of America or to any other country or county. You acknowledge that Green Ridge Island, the town of Green Ridge and the St. Christina facilities are not subject to any state laws. You acknowledge that any personal property transported to Green Ridge Island becomes the responsibility of GR Biotech and its subsidiaries. You hereby waive your right to register to vote in any states within the continental United States, within the states of Alaska and Hawaii, and within any US territories. You waive your right to representation by any political parties or persons within the aforementioned US locations or other countries. You acknowledge that you are legally bound not to disclose information regarding Green Ridge laws, protocols or procedures of any kind with persons not residing on Green Ridge Island. You acknowledge that visitors to Green Ridge Island become the sole responsibility of the undersigned, and are subject to the same laws, protocols and procedures as Green Ridge island residents during their stay. You acknowledge that visitors to Green Ridge Island are subject to surveillance by Green Ridge officials and employees, and may be removed from the island without notice. You acknowledge that any minors under the age of thirteen (13) that are claimed as dependants remain the sole responsibility of the undersigned, and are subject to the same laws, protocols and procedures as all Green Ridge Island residents. GR Biotech and its Subsidiaries reserve the right to add to or amend these terms of service at any time.

Please sign and date below:

Richard Ambery 30th May 2011

Welcome to Green Ridge. Below you'll find your pertinent residential, employment and scholastic information. Please take this time to familiarise yourself with the island layout and requisite handbooks, rules and regulations. Thank you for joining our community.

Residential Address: 309 Treasure Chest Road
Residents at this Address: Richard Ambery
Employment: Daisy Bank Farm Owner
Education: N/A


Final Application Approval Steps for Players:


Before you can begin play on STC, you must complete these final steps:

• Sign up your playby on the faceclaim.
  
• Sign up for the who plays who list.
  
• Sign up for your assigned membergroup (shown above) HERE (Pay close attention to pick the correct usergroup listed on this approval stamp! Characters that are not signed up for their correct membergroups after approval will be subject to deletion during the next activity check.)
  
• Familiarise Yourself with your Staff & Resident Handbooks, located in the St. Christina's Rosters and Information, and Green Ridge Rosters & Information forums, on the main board.

Code:

[center][font=garamond][size=22][color=#555555][b] -File Note- [/b][/color][/size][/font]

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[b]Resident Name:[/b] Ambery, Richard
[b]Residential Address:[/b] 309 Treasure Chest Road
[b]Employment:[/b] Daisy Bank Farm Owner
[b]Education:[/b] N/A

[center]_____________________________________________________________[/center]

[b]Note Subject:[/b] (Behavioural Report, Progress Report, Procedure Report, Disciplinary Report, etc.)

[b]Note Contents:[/b] (Explain behaviour observations, procedures, disciplinary actions, medical reports, etc. here)

[b]Note Author:[/b] (Your character name here.)

[b]Other:[/b] (Optional extra notes here.)