Nys paramedic pilot paperwork form 2026

1. Click ‘Get Form’ to open the NYS Paramedic Pilot Paperwork Form in the editor.
2. Begin by entering your EMT Number and Social Security Number in the designated fields. This information is crucial for identification and verification purposes.
3. Fill in your personal details, including Last Name, First Name, Middle Initial, Address, City, State, and Zipcode. Ensure all information is accurate to avoid processing delays.
4. In the affirmation section regarding criminal convictions, read carefully and check the box to confirm your understanding. Sign and date this section as required.
5. Complete the CPR Certification section by providing the Printed Name and Signature of your Instructor along with the Date. Remember to attach a copy of your CPR card if not signed by the instructor.
6. For ACLS Certification, enter both Issue Date and Expiration Date accurately. A copy of your current card must accompany this application.
7. Document your hours earned for EMT-Paramedic Refresher Training in each topic area provided. Ensure you meet the required hours for each category.
8. Complete the Skill Competency Verification section by having your Medical Director sign and date it after confirming proficiency in all skills listed.
9. Finally, affirm that all statements are true by signing at the bottom of the form along with your Sponsoring Agency Contact/Coordinator's signature and date.

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