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- 3- <br />EFERENCES (list three) <br />Name ~2tsz'~ Lo~~~~ Phone <br />Name 1. CS'rF7't Ey~t (DEL <br />Name /~'[.9r2fr7n~nr M 1 L ~rYC <br />C~`t1- tZ~• ~ <br />Phone ~2c5~ 3sG-8?~o Address <br /> <br />Phone G~ Z 3- SSZO Address !'~(-~ii , I"~IrVn,'t7'}/~oCIS~ ~„/ <br />How many days, weeks, or months of the year are you out of ..town for reasons other than <br />regular employment? qv~ Z w~cKS f ~r2. <br />I hereby apply for membership in the Falcon Heights Fire Department and Rescue Squad. Prior <br />to my acceptance I will have to~pass a complete physical examination and a physical agility <br />test. In addition, my acceptance is conditional upon my performance white on the Department. <br />If my performance falls below Department standards, my position may be terrr;inated at any time. <br />Otherwise, I will serve aone-year probationary period. At the end of that period 1 will be <br />accepted as a regular member of the department or my probationary period will be extended. <br />agree to abide by all by-laws and policies of the Falcon Heights Fire Department and Rescue . <br />Squad during my tenure with the Department. <br />j~ <br />V LYv~ <br />~ <br />- <br />~ Z~ 9 0 <br /> Signature Date <br /> <br />Address ZZZ3 ~ It.s~-P~ 5~ . S~cnk~ <br /> <br />