ElDoradoEMS@edcgov.us
2900 Fairlane Court Placerville, CA 95667
530-621-6500
For INITIAL Certification Only
You must have documents electronically copied (cards & forms) PRIOR to starting the online application process.
Be sure to read carefully and answer all questions.
You will need the following:
1. Copy of a current driver’s license or a government issued identification card
2. Copy of current National Registry Certification (NREMT card AND certificate)
3. Copy (front and back) of current CPR Certification taught to the curriculum standards of the American Heart Association, American Red Cross or the National Safety Council at the Health Care Provider or equivalent level
4. Copy of your EMT training program course completion certificate, must include epi-autoinjector, naloxone and glucometer certifications
5. A live scan criminal background check, completed no more than 60 days prior to the date the certification application is submitted. The El Dorado County EMS Agency Live Scan form must be used, and a copy of the completed form (once the live scan has been performed and signed by the technician) must be provided to the El Dorado County EMS Agency. https://www.edcgov.us/government/ems/forms/documents/LifeScanApplication012914.pdf
6. Non-refundable application fee. Checks are NOT accepted. To determine the application fee and acceptable payment methods, refer to: https://www.edcgov.us/Government/EMS/Pages/EMS_Application_Center.aspx
What is your Gender?
Age Range:
What is your Race/Ethnicity?
Date of Birth:
Personal Mailing Address (do not use your employer's address):
"I understand that I am solely responsible for notifying the El Dorado County EMS Agency in writing, within thirty (30) calendar days, of any changes to my mailing address or contact information."
In what setting will you be using your certification?
Will you be EMPLOYED or VOLUNTEERING as an EMT?
Employer Address
Have you applied for an EMT Certificate anywhere other than with El Dorado County EMS within the last 12 months?
Do you have an expired EMT Certificate issued by any other Certifying Entity?
The Medical Director shall deny or revoke an EMT certificate if any of the following apply to the applicant:
If you answer YES to any of the NEXT three (3) questions, then you MUST add/attach a detailed statement.
*Note: A box will open once you click YES to add/attach statement.
1. Have you ever had a certification, accreditation, or professional healing arts license denied, suspended, revoked or placed on probation, or are you under investigation at this time? If yes, you must add/attach a detailed statement with this application that describes the action, any corrective action, and/or remediation as a result of the action.
YES, to question #1 - ATTACH a detailed Statement HERE or write it above that describes the action, any corrective action, and/or remediation as a result of the action.
2. Have you ever been convicted of any felony or misdemeanor offense in California or in any other state or place, including entering a plea of nolo contendere or no contest, and including any conviction which has been expunged (set aside) or records sealed under Penal Code § 1203.4? If yes, you must add/attach a detailed statement describing the crime(s), date, location, court, sentence served, and parole if any. You must also attach any applicable court documents and police reports.
YES, to question #2 - ATTACH a detailed Statement HERE or write it above describing the crime(s), date, location, court, sentence served, and parole if any. You must also attach any applicable court documents and police reports.
3. Are there any criminal charge(s) currently pending against you? If yes, you must add/attach a detailed statement describing the charge(s), date, location, and court, if any. You must also attach any applicable court documents and police reports.
YES, to question #3 - ATTACH a detailed Statement HERE or write it above describing the charge(s), date, location, and court, if any. You must also attach any applicable court documents and police reports.
INITIAL CERTIFICATION REQUIRED DOCUMENTATION
I understand it is my responsibility to have current/valid certifications on file at all times with the El Dorado County EMS Agency. This means if a certification expires during my EMT certification period, it is my responsibility to submit a current copy to El Dorado County EMS Agency. (Emailing a copy is the preferred method of submission)
Government Issued Photo ID must show applicant to be at least 18 years of age at the time of application. (i.e., State Driver’s License, State ID card, Military ID card, Passport)
When does your Government Issued Photo ID expire?
ATTACH HERE a copy of your Government Issued Photo ID Card showing expiration date.
CPR certification must be taught to the curriculum standards of the 2015 American Heart Association (AHA) Basic Life Support (BLS) for Healthcare Providers CPR/Automated External Defibrillator (AED) Program, or equivalent level. Online CPR courses are not accepted.
Certificates and Cards must show "BLS Provider".
When does your BLS Provider CPR Certification expire?
Is your proof of BLS Provider CPR Certification on a CARD or a CERTIFICATE?
ATTACH HERE a copy of your BLS Provider CPR CERTIFICATE with bar code & authentication number, also showing expiration date.
ATTACH HERE a copy of the FRONT of your BLS Provider CPR CARD showing expiration date.
ATTACH HERE a copy of the BACK of your BLS Provider CPR CARD.
I understand that it is my responsibility to maintain confidentiality of patient medical information. In addition, I understand as a certified Emergency Medical Technician in El Dorado County I am responsible to know and adhere to all Policies & Protocols.
As an initial EMT applicant you must be fingerprinted using a the El Dorado County DOJ Live Scan form, it must be completed BEFORE an application is submitted, and can be found on our website. Form can be found here: https://www.edcgov.us/Government/EMS/Pages/EMS_Application_Center.aspx
When did you get your fingerprints taken?
ATTACH HERE a copy of your COMPLETED El Dorado County EMS DOJ Live Scan Form.
Per California Code of Regulations, Title 22, Division 9, Chapter 2. § 100077.
What is the completion date on your EMT School Course Completion Certificate? (must be within two (2) years from the date of application)
ATTACH HERE a copy of your EMT School Course Completion Certificate. (Note: NOT your NREMT Certificate and cannot be transcripts - MUST BE CERTIFICATE)
When does your NREMT Certification Card expire?
ATTACH HERE a copy of your NREMT Certification CARD showing expiration date.
If you need to submit any further documentation for your application, please email us at: ElDoradoEMS@edcgov.us
Be sure to include your name & phone # in the email.
A non-refundable application fee must be paid in order to process an application. The fee for an Initial EMT Application is $100.
Fees can be paid by following this link: https://www.edcgov.us/Government/EMS/Pages/emergency_medical_service_payments.aspx
I hereby certify under penalty of perjury that all information on this application is true and correct to the best of my knowledge and belief, and I understand that any falsification or omission of material facts may cause forfeiture on my part of all rights to EMT certification in the State of California. I understand all information on this application is subject to verification, and I hereby give my express permission for this certifying entity to contact any person or agency for information related to my role and function as an EMT in the State of California.
