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Complete at least the information in shaded areas; sign and date the application in ink; only origin

Complete at least the information in shaded areas; sign and date the application in ink; only origin 2025

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The document is an application form for the Advanced Emergency Medical Technician (AEMT) certification from the Imperial County Public Health Department's Emergency Medical Services Agency. It outlines the necessary steps for completion, including personal information requirements, continuing education documentation, and associated fees for initial certification or recertification. Additionally, it includes questions regarding criminal history and previous certifications, emphasizing the importance of truthful disclosure.

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