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No I document that any d with preju to particip inherently unforesee to myself. NOTICE Pursuant applicatio your priva rights in th As an app informatio authorize all approp persons o designees a confiden I herby re may resul Printed Na Signed: Sworn to Notary Sig Date Com _Author ote this form m ts included w deception, fals dice. I also a pate may caus y dangerous a en circumstan E TO ALL A to the Civil R n which you h acy rights whe his respect. plicant for a re on concerning the Lafayette priate inquires or organizatio s to release a ntial nature or lease you, yo lt from furnish and subscribe gnature:____ mmission Exp rization must be notarize ith this applic sehood or om m aware that se my remova activity and th nces may pres APPLICANT ights Act, you have the right en you answe eserve positio g my moral, p e Fire Departm s regarding th ns selected b any and all inf r privileged na our organizatio hing the inform ed before me ires: of Rele ed. Please print ation only con mission will be certain traini al from the de at should I be sent that coul TS: u are hereby a t to deem priv er any of these on in the Lafa hysical, educ ment, City of e above men by the Lafayet ormation that ature. on, agents, e mation herein e this ase of In t or type. All D affirm that th ntain stateme e grounds for ngs and othe epartment. I a e accepted in ld cause griev advised that t vate and not a e questions. B yette Fire De ational, and m Lafayette, an ntioned qualifi tte Fire Depar t they may ha mployees or requested. d nformat Dates mm/dd/y he above infor ents that are t immediate te er duties may am also aware to the Lafaye vous bodily h there are cert answer. It will By signing be partment, I am mental qualific d appropriate cations. More rtment, City o ave concernin others from a Date: day of tion____ yyyy. rmation and a true and corre ermination from be mandator e that the fire ette Fire Depa arm up to and tain questions l be considere elow you fully m required to cations. In thi e designees to eover, I autho of Lafayette a ng me, includi any liability or 2 any other ect. I am awa m the departm ry and my ina service is an artment d including de s on this ed a waiver o understand y o furnish is regard, I he o make any a orize those nd or appropr ng informatio r damage whi FD re ment bility n eath of your ereby and riate on of ch