FuTech Application Center

[Y'berg]

Name: Thomas Jayne

Date of birth (dd/mm/yyy): 11/10/803

Current residence: Canterbury, Planet Cambridge Contact details: Y'berg#2090
Prefix (Mr., Mrs., Ms): Mr. Suffix (Jr., Sr., other): -none- Gender: [x] Male [] Female

Education: Highest degree attained.

[] High School Diploma

[] Bachelor's degree (BS, BA, BCom etc.)

[x] Master's degree (MS, MA, MBA, etc.)

[] Doctorate

[] Other: <Your answer>

Year awarded: 826

Ethical standing: [] Check here if you have ever been convicted of a felony.

If the answer is yes, provide details:: <Your answer, delete if no>

Other prior background: Check the institution or companies you were affiliated with.

[] Liberty Navy
Official institutions (leave blank if none): [] [LN] - Liberty Navy Primary Fleet; [] 5th| Fifth Liberty Navy Fleet

[] Liberty Police Incorporated
Official institutions (leave blank if none): [] LPI- Liberty Police Incorporated

[] Deep Space Engineering

[] Ageira Technologies
Official institutions (leave blank if none): [] Ageira~ Ageira Technologies

[] Cryer Pharmaceuticals

[] Interspace Commerce
Official institutions (leave blank if none): [] IC| Interspace Commerce

[] Other: <Your previous faction alignment, delete if none)
Official institutions (leave blank if none): [] <Official Faction Tag> <Official Faction Name, delete both if blank>