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Table of Contents
100 – State Law & Regulation
200 – Local EMS Agency (LEMSA)
300 – Hospitals
400 – Provider Agencies
500 – Patient Destination
600 – Documentation & QI
700 – Equipment & Supplies
800 – Field Policies & Treatment Protocols
900 – EMS Personnel
1000 – Training Programs
1100 – Procedure Policies
Protocols (ALS/BLS)
Cardiovascular (ALS/BLS)
Respiratory (ALS/BLS)
Medical (ALS/BLS)
Neurological (ALS/BLS)
OB/GYN (ALS/BLS)
Environmental (ALS/BLS)
Trauma (ALS/BLS)
Pediatric (ALS/BLS) Protocols
Protocols (LALS)
Cardiovascular (LALS)
Respiratory (LALS)
Medical (LALS)
Neurological (LALS)
OB/GYN (LALS)
Environmental (LALS)
Trauma (LALS)
Pediatric (LALS – AEMT) Protocols
HPP
EMT/AEMT Recertification Application
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Name
*
First
Middle
Last
Application Type
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EMT Recertification
AEMT Recertification
Do you have a current or lapsed EMT or AEMT certification issued by a DIFFERENT California EMT Certifying Entity (LEMSA) than S-SV?
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Yes
No
If your EMT Certification is from any OTHER LEMSA like Sacramento County EMS, Nor-Cal EMS, El Dorado County EMS Agency, please check YES.
APPLICATION ERROR
If you have most recently certified with Sierra-Sacramento Valley EMS Agency, please above click "No". If this is your first time certifying with S-SV EMS, please complete an Initial Certification Application.
Current Certification Number
*
If this is your first time certifying with S-SV but are re-certifying your state EMT license, please reach out to our office for the correct application process. (916) 625-1701
Current Expiration Date
*
Birthdate
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What is your Race or Ethnicity?
American Indian or Alaska Native
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*
Telephone Number
*
Current EMS Employer (if applicable)
How Many Application File Attachments Do You Have To Upload? (3 MB Max File Size Per Attachment)
1
2
3
4
5
6
Please see "Recertification 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
File Upload
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File Upload
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File Upload
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File Upload
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File Upload
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File Upload
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Background Information
ATTENTION: If you answer yes to any of the following background questions, you must attach or submit a letter of explanation.
Have you ever been convicted of a felony or misdemeanor offense in California or any other state/place, including a plea of nolo contendere/no contest and, including any conviction which has been expunged under Penal Code Section 1203.4?
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Yes
No
Are you currently under criminal investigation or are there any criminal charges currently pending against you?
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Yes
No
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?
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Yes
No
Have you applied for EMT certification with any other California certifying entity or Local EMS Agency (LEMSA) within the previous 24 months?
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Yes
No
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 on my application 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 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 the S-SV EMS Agency to contact any person or agency for information related to my role and function as an EMT in California. I hereby authorize the S-SV EMS Agency to obtain applicable law enforcement records pertaining to my criminal activity as it relates to my role and function as an EMT in California. I understand that I may be required to provide copies of legal records related to my past criminal activity (if applicable), and the processing of my application may be delayed until these documents are provided to the satisfaction of the S-SV EMS Agency. I understand that I am solely responsible for notifying the S-SV EMS Agency in writing, within thirty (30) calendar days, of any and all changes of my mailing address.
SIGNATURE
*
Date
*
YOUR APPLICATION IS NOT COMPLETE
Your application is not complete and your certification will NOT be renewed at this time. Please reach out to our office ASAP so we can help you get this resolved. M-F 07:30-16:30 | (916) 625-1701
Do NOT Click the Submit button below. Please contact our office at your earliest convenience.
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