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Provides a contents list of DOH form numbers and page counts, application instructions, checklists, signature form requirements, and out-of-state credential verification. 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Contents List/SSN Information/ Mailing Information .............. 1 page  \n2. 530-061 .... Application Instructions Checklist......................................... 3 pages  \n2. 530-191 .... Certification Requirements................................................... 2 pages  \n3. 530-015 .... EMS Certification Application ............................................... 4 pages  \n4. 530-117 .... General Instructions Checklist and EMS  \nSupervisor/Medical Program Director Signature Form ........ 2 pages  \n5. 530-065 .... Out-of-State Credential Verification Form .............................. 1 page  \n6. RCW/WAC and Online Website Links...................................................... 1 page  \nImportant Social Security Number Information:  \nIf you have a Social Security Number, the law requires you to disclose it on your application for a professional or occupational license. 42 U.S.C. § 666(a)(13) ; RCW  26.23.150. It will be used under the state’s child support enforcement program to locate individuals for purposes of establishing paternity and establishing, modifying, and enforcing support obligations. You are not required to have or obtain a Social Security Number to apply for or obtain a license from the Department of Health. If you do not have a Social Security Number, you are still eligible to apply for and obtain a credential if you meet the requirements. Please see the Declaration of No  Social Security Number Form. Please call the Customer Service Center at 360-236- 4700 if you have questions.  \nIn order to process your request:  \nSend completed application  \nand other documents to:  \nDepartment of Health  \nEMS Credentialing  \nP.O. Box 47877  \nOlympia, WA 98504-7877  \nContact us:  \n360-236-4700  \nTo request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil. rights@doh. [wa.gov](wa.gov).  \nDOH 530-060 September 2021  \n(This page intentionally left bank)  \nApplication Instructions Checklist  \nImportant background check information: Washington State law authorizes the Department of Health to obtain fingerprint-based background checks for licensing purposes. This check may be through the Washington State Patrol and the Federal Bureau of Investigations (FBI) . This may be required if you have lived in another state or if you have a criminal record in Washington State. This would be at your own expense. All information should be handwritten clearly in blue or black ink. It is your responsibility to submit the required forms.  \nF Check the appropriate box: Initial, Upgrade, Reciprocity, or Challenge.  \nF Check if either apply:  \nRequest for Military Training and Experience Evaluation  \nSpouse or Registered Domestic Partner of Military Personnel  \nF 1. Demographic Information:  \nSocial Security Number: You must list your social security number on your application. You are not required to have or obtain a Social Security Number to apply for or obtain a license from the Department of Health.  \nPlease see the Declaration of No Social Security Number Form. Please call the Customer Service Center at 360-236-4700 if you have questions.  \nLegal Name: List your full name: first, middle, and last.  \nDefinition of legal name: “Legal name” is the name appearing on your official certificate of birth or, if your name has changed since birth, on an official marriage certificate or an order by a court. The court must have the legal authority to change your name. We may ask you to prove your legal name. If you use any name other than your legal name on this form your application may be denied.  \nBirth date: Provide the month, day, and year of your birth.  \nAddress: List the address we should use to send any information about your credential. Be sure to include the city, state, zip code, county, and country. This will be your permanent record with Department of Health until we have ","cbCaihDF6DPf1ieJ","https://ap.wps.com/l/cbCaihDF6DPf1ieJ","pdf",336798,17,"English","# EMS Certification Application Packet\n## Contents List and Instructions\n## Important Social Security Number Information\n## Application Submission Instructions\n## Background Check Information\n## Application Instructions Checklist\n## Demographic Information\n## Personal Data Questions\n## Education and Provider Status\n## NREMT Examination\n## Other License, Certification, or Registration","[{\"question\":\"Do I have to provide a Social Security Number to apply for an EMS credential in Washington?\",\"answer\":\"If you have a Social Security Number, the law requires disclosure on your application. You are still eligible to apply without one if you meet the requirements, and you must reference the Declaration of No Social Security Number form.\"},{\"question\":\"Who performs the background check for licensing and what could make it required?\",\"answer\":\"Washington law authorizes the Department of Health to obtain fingerprint-based background checks for licensing. The check may be performed through the Washington State Patrol and the Federal Bureau of Investigations (FBI), and it may be required if you lived in another state or have a criminal record in Washington.\"},{\"question\":\"What information must be provided for the NREMT examination section?\",\"answer\":\"Provide your national registry number and the date you took and passed the National Registry of Emergency Medical Technicians (NREMT) examination.\"}]","WA EMT Certification Application Packet - EMS Credentialing Forms | PDF",1790207399,43]