Get Examination Form - Department Of Health & Hospitals

Filling out the Examination Form from the Department Of Health & Hospitals is an essential step for those seeking EMT certification. This guide provides clear and concise instructions to ensure you successfully complete the form online.

Follow the steps to accurately fill out the Examination Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the personal information section, including your last name, first name, middle initial, mailing address, city, state, phone number, email, and social security number.
3. Select the appropriate certification level (EMT-Basic, EMT-Intermediate, or EMT-Paramedic) and indicate whether you are applying for an initial exam or retest.
4. Input the required CPR provider course number and CPR expiration date. Ensure that the course end date is also filled out.
5. Enter the program code and program name as specified by your course instructor or institution.
6. List the skills required for the retest, making sure to include all necessary practical skills.
7. Attach a copy of your driver’s license to the form, ensuring the photo is legible.
8. Have your course instructor sign and print their name, affirming their endorsement of your course completion and competency.
9. Sign the application yourself, as the application will be void without your signature.
10. Include payment in the form of a money order or cashier’s check made payable to the Bureau of EMS, as outlined in the fee structure.
11. Check the entire form for completeness before submitting it, ensuring all required documentation is attached.
12. Once everything is filled in and double-checked, save your changes, download, print, or share the completed form as necessary.

Start your application process by completing the Examination Form online today.