To submit this form, first, complete all required fields accurately. Attach supporting documents such as training certificates and identification. Finally, submit your application via the online portal or mail it directly to the SCEMSA office.

The important dates for this form are as follows: Initial certification effective date is May 1, 2023; the next review date is December 1, 2024; and it is necessary to renew your certification every two years.

The purpose of this form is to establish the standards and requirements for individuals who wish to certify as Emergency Medical Technicians in Sacramento County. It ensures that candidates meet the necessary qualifications and comply with state regulations. This document serves as both a guide and a formal application for certification.

• 1. Name: Full name of the applicant.
• 2. Contact Information: Includes phone number and email address for communication.
• 3. Training Proof: Documentation proving successful completion of an EMT training course.
• 4. Background Checks: Details regarding the applicant’s background checks.
• 5. Signature: Applicant’s signature to authorize the application.

If you fail to submit this form correctly, your application will be considered incomplete and may delay your certification process. Additionally, missing information can result in the rejection of your application requiring you to resubmit.

• Delayed Certification: If the form is not submitted correctly, you may experience delays in receiving your EMT certification.
• Incomplete Applications: Missing or incorrect information can lead to your application being deemed incomplete.
• Additional Fees: Resubmitting an application may incur additional fees and costs.

• 1. Initial Certification: When applying for your first EMT certification.
• 2. Certification Renewal: To renew an existing EMT certification before the expiration date.
• 3. Transfer from Out of State: When transitioning your EMT certification from another state to California.