HomeMy WebLinkAboutemt-certification-background-check Alameda County EMS – Background Check Required Revised: October 16, 2017 Page 1 of 2
BACKGROUND CHECK REQUIRED
FOR ALAMEDA COUNTY EMS
EMT CERTIFICATION
Background
All applicants for Alameda County EMS Agency EMT Certification must submit fingerprints for a criminal
history background check with the California Department of Justice (DOJ) and the Federal Bureau of
Investigation (FBI). Fingerprinting is done using “Live Scan” technology and uses computer images to
send fingerprints immediately to the DOJ and FBI. If you hold certification through another EMS agency
and wish to recertify through ALCO EMS, you will need to do a DOJ and FBI Live Scan for us.
Getting a Live Scan Form
Live Scan forms can be printed from our website or picked up in person. Our website allows you to
print a copy of the form. You should print three copies, one for the Live Scan agency, one for EMS and
one for you. The forms should be completed prior to arriving for your Live Scan appointment.
Live Scan Agencies
Contact a Live Scan Agency to make an appointment. When you go for your Live Scan, make sure they
can do both the DOJ and FBI submissions. The list includes hours of operation, cost, whether or not an
appointment is necessary, and method of payment. Locations of Live Scan agencies can be found on
the Internet at http://ag.ca.gov/fingerprints/publications/contact.php.
Privacy Guarantee
Privacy and confidentiality of criminal history record information is the responsibility of the EMS
Agency.
If you have a conviction history
Conviction of a crime does not necessarily mean that an applicant will be denied certification. The
appropriate EMS staff, along with the county legal department if appropriate, will review each case
where the applicant has a criminal conviction. Decisions will be based on applicable state statutes and
regulations, and a careful review of documentation. If an applicant is denied, he/she has the right to
request a hearing. In addition, an EMT certificate may be suspended or revoked based on criminal
history information. Applicants with a criminal conviction or who are involved in an active prosecution
can expect a delay in the processing of their application. For us to process you application, you must
submit a letter explaining the case and copies of the final court docket/disposition which will help us in
the decision process.
What to submit with your application
Applicants must submit a copy of the Live Scan form with their certification/recertification paperwork.
Certifications will be issued after review of the application, associated documentation, the results of
the background check, and receipt of the EMT certification fee.
Questions can be directed to Scott Salter, EMS Coordinator (scott.salter@acgov.org) at (510) 618-2022.
Alameda County EMS – Background Check Required Revised: October 16, 2017 Page 2 of 2
DIRECTIONS FOR COMPLETION OF LIVE SCAN FORM
Complete the fields listed below. If you are using a printed form off the website, some of this
information is already completed:
Applicant Submission Section
ORI: A1958
Authorized Applicant Type: Emerg Med Tech Lic/Cert
Type of License/Certification: Alameda County EMS
Agency Authorized to Receive Criminal Record Information: Alameda County EMS
Agency
Mail Code (five digit code assigned by DOJ): 07337
Street No. Street or P.O. Box: 1000 San Leandro Blvd, Suite 200
Contact Name: Scott Salter
City: San Leandro
State: CA
Zip Code: 94577
Contact Telephone Number: (510) 618-2022
Applicant Information Section
Name of Applicant: Enter your last name, first name and middle initial
Other Name (AKA or Alias): Enter any other names you’ve used
Date of Birth: Enter your date of birth
Sex: Check the appropriate box
Driver’s License Number: Enter your California Driver’s License number
Height: Enter your height (feet and inches)
Weight: Enter you weight
Eye Color: Enter your eye color
Hair Color: Enter your hair color
Place of Birth: Enter you place of birth
Social Security Number: Enter your social security number
Home Address: Enter your home street address, city, state and zip coed
Level of Service: Check the DOJ box and the FBI box
Employer Section
Employer Name: EMSA
Mail Code: 02531
Address: 10901 Gold Center Drive, Suite 400
City: Rancho Cordova
State: CA
Zip: 95670
Telephone Number: (916) 322-4336
DO NOT COMPLETE ANY OTHER FIELDS ON THE FORM!
(If the form is filled out incorrectly, DOJ may reject it, requiring the