Join Us Today

Fill out our application form and join the ranks of volunteer firefighters that keep our community safe.

Membership Application

Your journey begins with the application below.

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Phone Number*

Email Address*

Are you able to engage in intense physical activity and lift heavy objects of at least 50 lbs ? *

Yes

No

Do you have any disabilities, impairments, or medical conditions? *

Yes

No

If Yes, describe below

Are you 18 years or older?*

Yes

No

Do you have previous firefighting experience?*

Yes

No

If Yes, describe below

List any firefighting certificates held

Have you ever been convicted of a felony?*

Yes

No

Have you ever been a member of Acme Hose Company No. 1*

Yes

No

Emergency Contact Primary*

Emergency Contact Secondary

Are you employed?*

Yes

No

If Yes, enter employment information below.

May we contact your employer?

Yes

No

High School Attended*

Did you graduate?*

Yes

No

College/University Attended

Did you graduate?

Yes

No

References*

How did you hear about us?

Acme Hose Compnay No. 1

Contact Us:

Join Our Mailing List

Phone: 570-421-5690

380 Chestnut

East Stroudsburg, PA 18301

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