Get Nys Doh 4226

The Nys Doh 4226 form is an essential document for individuals participating in the Continuing Education Recertification Program for Emergency Medical Services in New York. This guide will provide clear, step-by-step instructions on how to accurately complete the form online.

Follow the steps to successfully fill out the Nys Doh 4226 form.

1. Click ‘Get Form’ button to access the Nys Doh 4226 form and open it for completion.
2. Begin with the personal information section. Provide your first name, middle initial, and last name in uppercase letters. Ensure all fields are filled in carefully.
3. Enter your address details including street, city, state, and ZIP code. Make sure this information is current and accurate.
4. Fill in the county of residence.
5. Indicate your sex by selecting the appropriate option.
6. Enter the first four digits of your Social Security Number, and then provide the name of your participating agency along with the DOH agency code.
7. List your EMT/AEMT number and check the box for the appropriate certification level based on your qualifications.
8. Include your EMT/AEMT expiration date and provide a preferred contact number for any communication related to the application. You can enter a home, work, or cell phone number.
9. In the Personal Affirmation section, indicate that you have no criminal convictions. If applicable, be aware that convictions will be reviewed individually.
10. Sign the application, date it, and ensure you have read the requirements outlined for the Continuing Education Recertification Program before signing again in the designated area.
11. Lastly, review all information for completeness and accuracy before saving your changes, and download or print the completed form for your records.

Complete your Nys Doh 4226 form online today to ensure your participation in the recertification program.