ElDoradoEMS@edcgov.us
2900 Fairlane Court Placerville, CA 95667
530-621-6500
For RENEWING 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.
To recertify an El Dorado County certfication, you will need:
1. Copy of a current driver’s license or a government issued identification card.
2. 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.
3. Completed EMT skills competency verification form.
4. **Effective 7/1/2019 copy of Certificate of Training or CE Certificate for Naloxone, Epinephrine and Glucometer training.
5. Documentation of twenty-four (24)* hours of continuing education (MUST be CE Certificates), obtained during the current certification period. If expired, CE must be dated within 24 months prior to applying for reinstatement.
6. Complete a Department of Justice and FBI Live Scan background check, if not previously on file with the agency.
7. 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
To recertify your EMT Certification that was issued by another Agency (Reciprocity Certification):
3. Copy of current National Registry Certification (NREMT card AND certificate).
4. Copy of your out-of-County/State EMT card.
5. A live scan criminal background check, completed no longer 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/Pages/EMS_Application_Center.aspx
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 El Dorado County in writing, within thirty (30) calendar days, of any changes to my mailing address or contact information? (A change of address form can be found on the El Dorado County EMS website.)
Will you be EMPLOYED or VOLUNTEERING as an EMT?
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?
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.
RENEWING CERTIFICATION REQUIRED DOCUMENTATION
I understand it is my responsibility to have current/valid certifications on file at all times with El Dorado County EMS. 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. (Emailing a copy is the preferred method of submission)
Examples: 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 American Heart Association (AHA) or equivalent. 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: Copy of your BLS Provider CPR Certificate with bar code and authentication number, also showing the 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.
The Skills Verification form must be signed off by authorized EMS personnel (e.g. Field Training Officers).
ATTACH HERE a copy of your current CA EMT Skills Competency Verification Form (SCV 01/17)
When does your current expiring State EMT Certification expire?
ATTACH HERE a copy of your current expiring State EMT Certification Card showing expiration date.
Is your EMT Certification expired 6 months or more?
EMT Re-Certification requires 24 Continuing Education Hours or a 24-hour Refresher Course Certificate.
Continuing Education Certificates must show an EMS CE Provider or CECBEMS number and be taken within the current certification 2-year period.
College courses can count towards an EMT's CEs for recertification. You must send official transcripts for verification. Types of courses that apply are: physical, social or behavioral sciences, anatomy, physiology, sociology, and psychology. At least 50% of the required CEHs must be in a format that is instructor based. Unofficial transcripts are not excepted.
Effective July 1, 2019, recertifying EMTs must include a CE Certificate or a EMT Refresher Course that states training on “epi, naloxone and glucometer” on the certificates. Training must be taken during the EMT’s two (2) year Certification period. Note this is separate from the State Skills form.
Upload Recommendations:
ATTACH HERE all copies of your Continuing Education Certificates.
ATTACH HERE any additional CE Certificate hours that were not uploaded above.
Do you need to upload more files?
Special Note: There are additional requirements for an EXPIRED EMT Certification.
If you Certification is EXPIRED:
*All Continuing Education Certifications must show EMS CE Provider number.
** If you are not able to upload all your CEs in one or two attachments below, then please email them to El Dorado County EMS (ElDoradoEMS@edcgov.us). Include your name and phone number in the email.
ATTACH HERE all copies of your additional required items as listed above.
ATTACH HERE any additional documents that were not uploaded above.
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 number in the email.
A non-refundable application fee must be paid in order to process an application. The fee is:
$62.00 if your license is current
If your license has expired, there is an $88.00 late fee in addition to the $62.00 fee (total $150.00)
If you require a rush recertification, there is an additional fee of $88.00
Fees can be paid online by going to: 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.
