Instruction Guide for the Application for
Emergency Medical Technicians (EMT)
Examination and Licensure

EXAM CANDIDATES MUST HAVE COMPLETED ALL COURSEWORK AND FINAL EXAMS BEFORE TEST ENROLLMENT

INSTRUCTIONS

Provide all applicable information requested on all three pages of the application. Missing information on the application will result in a delay of enrollment.

Part I – Application Category Information (Required)

  1. Enter Profession Name (Choose one from below)

    1. EMT-B for Basic

    2. EMT-I for Intermediate

    3. EMT-P for Paramedic

  2. Enter Profession Code (Choose one from below)

    1. 600 for EMT-Basic

    2. 601 for EMT-Intermediate

    3. 602 for EMT-Paramedic

  3. Enter applicable Fee (Fee must be in the form of money order, cashier’s check or group check and made payable to Continental Testing Services). No cash or personal checks will be accepted.

    1. $20.00 for EMT-Basic

    2. $30.00 for EMT-Intermediate

    3. $40.00 for EMT-Paramedic

If an unexcused absence occurs, testing fee is forfeited and will not be refunded.

  1. Appropriate Information Regarding Application

    1. Check box for first time application

    2. Check box for second time application

    3. Check box for third time application

    4. Check box and write explanation for four and/or more application

Part II – Applicant Identifying Information

  1. Complete all information (Required)

  2. U.S. Social Security Number (Required)

  3. Permanent Mailing Address (Required)

  4. Employment (Check off current employment or volunteer status within the EMS System) (Required)

  5. Maiden Name

  6. Driver’s License Number (Required)

  7. Driver’s License State (Required)

  8. Race/Ethnicity (Optional)

  9. Place of Birth, City, State, Country (Required)

  10. Date of Birth (Required)

  11. Gender (Required)

  12. Telephone Numbers (Work and Home) (Required)

  13. E-mail Address

Part III – Education Information

  1. Preliminary Education (Circle number of years completed) – check yes or no for high school graduated or GED

  2. Name of Last School Attended

  3. Last School Location (include City and State)

  4. Date of Graduation (Month and Year)

Part IV – Record of Licensure Information

Individuals licensed in a U.S. jurisdiction, a foreign country or province must state whether or not they have ever held licensure (either temporary or permanent) to practice as an EMS Professional (If applicable).

Part V – Record of Examination

Please complete if you have taken the exam for the same level of this profession from National Registry or another state. Failure to disclose examination attempt may result in denial of your application or other appropriate action.

Part VI – Personal History Information (Disclosure of this information is voluntary

  1. Criminal Offense Conviction (Check Yes or No) (If yes, attach a certified copy of the court records regarding your conviction, the nature of the offense and date of discharge, if applicable, as well as a statement from the probation or parole office.

  2. Felony Conviction (Check Yes or No).

  3. Certificate of Relief from Disabilities by the Prisoner Review Board (Check Yes or No).

  4. Performance Functions (Check Yes or No).

  5. Denied or Discipline for a Professional License or Permit (Check Yes or No) If Yes, attach explanation.

  6. Discharged Other than Honorably Discharged from Armed Services (Check Yes or No).

Part VII – Examination Coding Information (Required)

  1. Enter Test Center Code for the chosen test site/date.

  2. Enter your training program site code. This code is provided by your instructor or EMS System (Resource Hospital).

  3. Record the number of times you have taken this EMT level exam.

  4. Special Accommodations (Check Yes or No).

Part VIII – Child Support and/or Student Loan Information

  1. Child Support and/or Student Loan Status.

    This information is required by law and signing certifies that all information is true and correct. Applications will not be processed unless check boxes are completed.

Part IX – Certifying Statement

  • The application must be signed and dated by the applicant, certifying that all information is true and correct.

  • The signatures of the System Medical Director and the System EMS Coordinator are required.

Applications without the signatures of the System Medical Director and the EMS System Coordinator will not be processed.

APPLICATION SUBMISSION

THE COMPLETED APPLICATION AND TESTING FEE, MADE PAYABLE TO CONTINENTAL TESTING SERVICES, SHOULD BE SUBMITTED TO YOUR EMS SYSTEM (RESOURCE HOSPITAL), FOR PROCESSING.

Upon verification of application, you will receive a confirmation letter from Continental Testing Services. The confirmation letter must be taken to the test site along with a government issued photo id such as a driver’s license or state identification card. Please arrive at the test site thirty (30) minutes prior to test time for check-in.

Applications, with instructions, can be found at www.idph.state.il.us/ems or www.continentaltesting.net.

If you need further assistance with this application, please contact Continental Testing Services (CTS) at 1-800-359-1313.






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Illinois Department of Public Health
535 West Jefferson Street
Springfield, Illinois 62761
Phone 217-782-4977
Fax 217-782-3987
TTY 800-547-0466
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