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Nys doh form 4226-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling in your personal information. Enter your First Name, Middle Initial, and Last Name in uppercase letters as instructed.
- Complete your Address, City, State, and ZIP Code. Ensure all fields are filled out accurately to avoid delays.
- Provide your County and select your Sex. Then, enter your Social Security Number and Participating Agency details along with the DOH Agency Code.
- Indicate your EMT/AEMT Number and check the appropriate certification level you are applying for.
- Fill in the Expiration Date of your EMT/AEMT certification and provide contact numbers: Home Phone, Work Phone, and Cell Phone.
- Read the Personal Affirmation section carefully. If applicable, affirm that you have no criminal convictions before signing.
- Finally, sign and date the form at the bottom to confirm your understanding of the program requirements.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4.9 Satisfied (34 Votes) |
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