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Date Received _~-~;~- ~'°d~J <br />•PE RS ONAL INFORMATION <br />Name ~ 1 Lt S <br />~~~-~~~~Date of Birth ~' 1 - l 5 - (~ ~--~ <br />Last F i rs t Middle ~~""'°'""°"`" <br />(No applicant under 18 or over 40 years of age is eligible). <br />Address ~~ ~~ LL~S"Il~ ~ ( ~v~t~(~-0(jt_~ M~~ ~~ <br />Street City State Zi ~m~""~~ '# <br />Telephone ~4'~ z - ~ lE3 ~ ~Z - Z y (r ~? Soc. Sec. # <br />-~ ~' ~ ~ <br />5 ~ ' ~+ ~ Z. (~ <br />home work - <br />Own Home .Buying Home Renting <br />How long have you 1 ived in Falcon Heights? ~~:= ~ C;+~ ~= ~+~ ~ ~ t~.2S <br />EDUCATION <br />. Name and Location Years A ndPd Graduated <br />< Grammar School <br />High S choo 1 ~~2L u-` ~ t~ !-~ . S . f-! AR T~~.~~'~j, t,.~12 ~ ,~ <br /> <br /> <br />0 the r ~ ~ (~~] (` EI~'1 - ~ M r e~,'l~t~i°0 ~. ~ S Cr?zTiFl r~ r ~ 19i; CQ <br />~ P Elf w .9 Tf-~2 ~ ~ r~.A t~ l v t12 _ ~~-~- i 19~ z ~ <br />STi4,~T~~J ~l2L= F7 GiYTt 2 L ~wrsecw~„~r ~ racy , <br />n ~, <br />l~-'~• Ft~ST - A~ ~ , .~}y / F,~ 5-r~r /J L V/-~-~+T <br />, c-P/:. A~fA~ Cf~ <br />.~ <br />~ Include any first aid, EMT, and firefighter training. <br />EMPLOYMENT <br />Present Employer 1~I~CT. ~M~~J(~'~2. ~yS ~/JC No. of Years 2.^totiT-rs <br /> <br />Business Address _ 3055 ~c.J ~c„ty i, -"'~p~S ,•1 n1 Working Hours ~'` - S P <br /> <br />Former employers (1 ist your last two employers starti ng wi th the most recent employer). <br />Name ~ Address of Employer Dates E toyed Position Reason for Leavin <br />~M S <br />pt7J~/~?c e0 SoSl <br />o~ <br />From: 3- ~~ ~!~-z_,p <br /> <br />° <br />~ ,~t,puv'~- cv~.uT ' rC, /~ c li'E <br /> To• <br />~ ~~ <br />TD /J r1P/ dt~ , ~ <br />• Z - `l 0 <br />~1M' bed ~~n-f e~-~y <br />rvt inrvt"S ~ n-- :.! From : S- 88 'T/"~~ ~•.~ ~ :r s P~: Sc ~cni <br />To: J -~~ A-5S~ l ' <br />CITY OF FALCON HEIGHTS <br />FIRE DEPARTMENT AND RESCUE SQUAD <br />App 1 i ca t i on for Membe rs h i p <br />~~~ <br />