Paramedic Initial Accreditation Application |

Applicant Information & Document Uploads

Name *

First

Middle

Last

Mailing Address *

Address Line 1

City

State

Zip Code

Email Address *

Telephone Number *

Employer (enter "N/A" or "None" if not applicable) *

California Paramedic License Number *

California Paramedic License Expiration Date *

How Many Application File Attachments Do You Have To Upload (3 MB Max File Size Per Attachment)?

Please see "Initial Accreditation Instructions" on the previous page for a list of required documents. Any documents that are unable to be uploaded can be e-mailed to our mailbox: INFO @ ssvems.com

Paramedic Accreditation Class Attendance Date

Please select the date/location of the class you are registering to attend from the dropdown list below.
Note: All classes are held from 9:00 am - 1:00 pm at the S-SV EMS Rocklin Office (535 Menlo Drive, Suite A) or S-SV EMS Redding Office (1255 East Street, 2nd floor conference room).

Class Date *

Attestation and Electronic Signature

By typing my name in the signature box and entering today's date, I hereby certify under penalty of perjury that all information is true and correct to the best of my knowledge and belief. I understand that any falsification or omission of material facts may cause forfeiture on my part of all right to paramedic accreditation by the S-SV EMS Agency. I understand all information on this application is subject to verification, and I hereby give my express permission for the S-SV EMS Agency to contact any person or agency for information related to my role and function as a paramedic.

SIGNATURE *

Date *

Message