Initial EMS Certification Application Packet

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EMS Certification Application PacketContents: 1. 530-060 ....Contents List/SSN Information/ Mailing Information ..............1 page2. 530-061 .... Application Instructions pages2. 530-191 .... Certification Requirements ........................................ ...........2 pages3. 530-015 ....EMS Certification Application ........................................ .......4 pages4. 530-117 ....General Instructions Checklist and EMS Supervisor/Medical Program Director Signature Form ........2 pages5. 530-065 ....Out-of-State Credential Verification Form.

Provide your national registry number and the date that you took and passed the National Registry of Emergency Medical Technicians (NREMT) examination. F 6. Other License, Certification, or Registration: List all states, including Washington, where health care provider credentials are or were held.

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