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APPLICATION FOR MEMBERSHIP <br /> CITY OF RAMS,EY FIRE DEPARTMENT <br /> <br />Name 1.' <br /> <br />Distance from Permanent Residence to Ramsey City Hall.. , ~", c7 <br /> <br />Are you 18 yearn or older? <br /> <br />state zIp <br /> <br />YES x' NO Phone Number (~/~) /.,/x// :?~C-~.,?/ <br /> ,.. ~ ! . ~c~ ~. ~ · <br /> <br /> /~-tt?.'f>'ex ~':' Date you can stan ~Tr"r~F-.',¢~-¢'?..f'c'' )/ <br /> <br />ttave you filed an application here before? YES NO '~ If yes, give date <br /> <br />Referral Source: Ad ~, Friend Relative <br /> <br />Walk-tn Other <br /> <br />Are you n°w employed? ~ S~ <br /> iT./CC .~_"dl?. ~ /_. / C..cYf tl , ~. NO <br />Occupation <br /> <br />Employer <br />Address street d city <br /> <br />ff yes, please complete the following: <br /> <br />z~p <br /> <br />List hours available <br /> <br /> Mort. Tue. Wed. Thur. <br />Please provide current D.L. #, Class & Expiration Date: <br /> <br />Fri. Sat. Sun. <br /> <br /> ,_ '~--- Class ~ Expiration Date <br />License #ff'-t/ ~,~ -i 3 ~-l~ fi:-~ '~ ~ <br /> <br />Related education/experience for fire fighting <br />PERSONAL REFERENCES <br /> <br />Please list 3 people you have known for at least 1 year not related to you. <br /> <br />Name Address Phone <br />i, ~' / ,; <br /> <br /> Years <br />Occupation Acquainted <br /> -~-. i ~.,~ .-- <br /> <br />I authorize investigation of all statements contained in this apphcation as ma)' be necessary, to determine <br />eligibility for membership. I ce,wi_fy ,,hat answers given herein are true and complete to the best of my <br />knowledge and I understand that, ff accepted, falsified statements on this application shall be grounds <br />for dismissal. I understand and agree that, if accepted, my membership is for no definite period and may <br />be terrtffnated at an.,,' time..., 5. <br /> <br />Sigrf~-ui'e D~e <br /> <br /> <br />