048-10 Wyo. Code R. §§ 10-2 - Application

(a) Any individual desiring to be certified as a FR, EMT Basic, EMT Intermediate, or Paramedic shall submit to the Division an application in the format prescribed by the Division. Applications for EMT Basic, EMT Intermediate, and Paramedic shall include a fee of two ($2.00) payable to the State of Wyoming. The application shall at a minimum contain the following information:

(i) Full name, current address and legal residence;

(ii) Age, height, weight, color of eyes and hair;

(iii) Proof of current medical certification desired;

(iv) Category of EMS certified desired;

(v) Whether the applicant has been convicted of a crime against a person, a felony, or an offense against morals, decency and family;

(vi) Whether the applicant has ever been subject to limitation, suspension, or termination of their right to practice in a health care occupation or voluntarily surrendered a health care certification or license in any state or to an agency authorizing the legal right to work;

(vii) If applying for EMT Basic, EMT Intermediate, or Paramedic certification, submit a completed Wyoming EMT physician sponsor form; and

(viii) Social Security number.

Notes

048-10 Wyo. Code R. §§ 10-2