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APPLICATION FOR MEMBERSHIP <br />CITY OF RAMSEY FIRE DEPARTMENT <br /> <br />Ni~me <br /> <br />PerrnanentAfldress /b---.~ a20 'Z-; ~c_o,, ,',/~ /~- <br />Distance from Permanent Residence to Ramsey City Hall <br /> <br />111'8l <br /> <br /> RECEIVED <br /> AUG 2 7 t991 <br />ctns'd..~ ........ <br /> <br />Are you ] 8 years or older? YES~//NO <br /> <br />Have you filed an application here before? YES.__ <br /> <br />Phone Number (e//)- ) qiz/ qc/dS'-~ <br /> Date you can sm -~--~,Z5 7~ / <br /> NO ~'/ ff yes, give date <br /> <br />Referral Source: Ad <br /> <br />.. Friendy' Relative~ <br /> <br />Are you now employed? <br /> <br />A~ess <br /> <br />Walk-In Other <br /> <br />ff yes, please complete the following:, <br /> <br />List hours avaUable//~ .,,.o Vt> z/,' oo /~'/~'? ) <br /> Mort. Tue. W~. ~. <br />Ple~ provide cU~nt D.L. g, Cl~s & Exp~fion D~: <br /> <br />Related education/experience for fire fighting <br /> <br />PERSONAL REFERENCES <br /> <br />Please list 3 people you have known for at least 1 year not related to you. <br /> <br /> Years <br />Name Address Phone Occupation Acqu aimed <br /> <br />I auth or/ze investigation of all statements contained in this application as may be necessary to determine <br />eligibility for membership. I cerfif-y that answers given herein are true and complete to the best of my <br />knowledge and I understand that, if accepted, falsified statements on this application shall bc grounds <br />for dismissal. I understand and agree that, if accepted, my membership is for no definhe period and may <br />be terminate.~pat any time; . <br /> <br /> <br />