Piermont Fire Department -Empire Hose Co. # 1
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Home
How to Join
Membership Information
Membership Application
Parent/Legal Guardian Consent Form
Events
About Us
History
Members
Apparatus
Member Only Files
Member Login
Contact Us
Donate!
Membership Application
Application
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Phone
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Email Address
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Date of Birth
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Age
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Are you a Rockland County Resident
Yes
No
Are you a U.S. Citizen or hold a work Visa?
Yes
No
Do you live within (5) miles of the Piermont Fire Department
Yes
No
Have you ever been a member of a fire company?
Yes
No
If yes please name company
If yes please name company
Why did you resign or relinquish your membership?
Please provide a letter of good standing from your previous company signed and dated
What section of the Fire Department are you interested in ?
Fire
EMS
Fire Police
Dive Rescue
High Angle Rescue
Have you received any Firematic, EMS, Dive or High Angle Rescue training? If so, please state.
Are you willing to stand watch at an emergency scene for several hours during the day or night if asked to do so?
Yes
No
Will you keep your dues paid in advance?
Yes
No
Will you parade?
Yes
No
Have you ever been convicted of a felony?
Yes
No
If yes, please state
If yes, please state
Were you ever convicted of arson?
Yes
No
If yes, please state
If yes, please state
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