ElDoradoEMS@edcgov.us
2900 Fairlane Court Placerville, CA 95667
530-621-6500
For INITIAL Accreditation 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.
1. Copy of a current driver’s license or a government issued identification card
2. Be at least 18 years of age.
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 Paramedic License
5. Letter of Affiliation from an approved ALS Service Contractor
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:
I understand that I am solely responsible for notifying El Dorado County EMS 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 EMS website.)
Employer Address
Are you currently authorized/accredited in any other Agencies, Counties, or States?
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 ACCREDITATION "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 Paramedic Accreditation period it is my responsibility to submit a current copy to El Dorado County EMS. (Emailing a copy to ElDoradoEMS@edcgov.us is the preferred method of submission)*
When does your current Paramedic State License expire?
ATTACH HERE a CURRENT copy of your Paramedic State License Card showing expiration date.
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.
I understand that it is my responsibility to maintain confidentiality of patient medical information. In addition, I understand as an accredited Paramedic in El Dorado County I am responsible to know and adhere to all of their Policies & Protocols.
Paramedics must request a letter of employment from an El Dorado County ALS Service Provider.
ATTACH HERE a letter of Employment from an El Dorado County ALS Service Provider.
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. Fees can be paid online here: https://www.edcgov.us/Government/EMS/Pages/emergency_medical_service_payments.aspx
Initial Accreditation Application Fee is $35.00.
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 Paramedic accreditation 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 a Paramedic in the State of California.
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