Covington Volunteer Fire Department  Covington, Virginia 24426 (540)965-6392  APPLICATION FOR MEMBERSHIP  APPLICATION FOR ACTIVE MEMBERSHIP IN THE COVINGTON FIRE DEPARTMENT MAY BE APPLIED FOR BY. ANY PERSON EIGHTEEN (18) YEARS OF AGE OR OLDER ANDLIVING WITHIN THE BOUNDARIES AND BEING THEIR PRIMARY PLACE OF RESIDENCE. NORTH - Includes Intervale, Clearwater Park, Clearview Estates, River Edge Retreat and EAST-To Island Ford Bridge, Valley Ridge maximum limiti is to Alleghany Memorial Park. On Route 676 (Dolly Ann Drive) which includes Valley Brook Subdivision. Maximum limit is to top of SOUTH- Includes Cherokee, Indian Valley. Maximum limit is bridge at Walton's Farm. WEST-Humpback Bridge is in the gray area. Maximum limit is Exit 10 on 1-64.  MEMBERSHIP BOUNDARIES ARE AS FOLLOWS:  Dunbrack Road. The maximum limit is Deep Ford Bridge.  the mountain.  REVISED SEPTEMBER 25, 2001  I hereby respectfully apply for admission into the Covington Fire Department and promise that if elected I will abide by the Laws, Rules, and Regulations of the Department.  NAME:  (LAS7)  (FIRST)  (MIDDLE)  ADDRESS: AGE:  HEIGHT:  WEIGHT:  DATE OF BIRTH:  SS No#  MARITAL STATUS: MARRIED DJ DIVORCED EJ SINGLE DJ    TELEPHONE No#: HOME  WORK  PAGEI  Do you possess a valid Virginia Driving Operators Do you have any MENTAL or PHYSICAL illnesses, conditions, or defects that could prevent you from  License?  YES  NO  performing as a firefighter? YES  NO  If Yes, please explain;  Have you ever been charged or convicted with a crime, (including motor vehicle violations)?  Yes  No  If Yes, please explain;  Has your operators license ever been SUSPENDED or  REVOKED?  Yes  No  If Yes, please explain;  Have you ever been a member of any other Fire Department or Company in or outside of the State of  Virginia?  Yes  No  If Yes, Name and address of organization;    PAGE  PLEASE SUBMIT, WITH THIS APPDICATION, A TRANSCRIPT OF YOUR DRIVING RECORD. THIS TRANSCRIPT CAN BE OBTAINED AT THE VIRGINIA DEPARTMENT OF MOTOR VEHICLES OFFICE. TRANSCRIPT FEE WAIVER ATTACHED TO  THIS APPDICATION).  I hereby certify and affirm that all information on this application is true and correct. NOTE False Statement, False Information, or Misrepresentation Will Be Grounds For Rejection Of  (Any  This Application). APPLICANT:  (SIGNATURE)  WITNESS TO THIS APPLICATION:  (CFD MEMBER ONLY)  DATE WITNESS: CHAIRMAN  COMMITTEE MEMBERS ON THIS APPLICATION:  PERMISSION TO INVESTIGATE  You, the investigating committee, are hereby authorized to make any investigation of my criminal record through any police angency. You may also investigate my personal history and educational record through any investigative agencies and educational institutions as deemed necessary by the  investigating committee.  APPLICANT: DATE:  PAGE 3    THIS IS TO CERTIFY THAT  was  duly elected to a one (1) year Probationary Membership in the Covington Volunteer Fire  Department at a meeting held on  20  and that he is entitled to have the Oath Of Office administered. During the probationary period and upon completion, he shall be subject to Article III, Section 8 of the Constitution and By-Laws.  SECRETARY:    PAGE 4  OATH OF FIREFIGHTER  do solemnly swear  that i will support the constitution of the united states and the constitution of virginia, ordained by the convention which assembled in the city of richmond on the 12th. day of. june, nineteen hundred and one, and that I will faithfully and impartially discharge and perform all the duties incumbent upon me as a firefighter in the city of covington, county of alleghany, virginia, according to the best of my  ability.so help me god.  subscribed and sworn to me this  day of  20  PAGE 5  COVINGTON FIRE DEPARTMENT COVINGTON, VIRGINIA 24426    TO: Division Of Motor Vehicle Officials,  This notice is confirming that  is  applying for membership to the Covington Volunteer Fire Department and is required to obtain a copy of their Virginia Vehicle Driver's Transcript to be put on file with the application. It's my understanding if Chief of Department confirms if individual applying, the monetary fee  will be waived.  Yours In Firefighting,  Wes Walker  Covington Fire Chief  PAGE 6