Homepage Blank C 08 B Georgia Form
Outline

The C 08 B Georgia form is a crucial document for individuals seeking out-of-state licensure as Emergency Medical Services (EMS) professionals in Georgia. This application serves multiple purposes, primarily facilitating the certification process for EMTs, paramedics, and other EMS providers who are licensed in other states. Applicants must submit a completed form along with a non-refundable fee, which varies depending on their level of certification—$75 for Basic, $85 for Intermediate, and $150 for those whose certification has lapsed for two years or more. Essential personal information, including legal name, Social Security number, and contact details, must be clearly provided. Additionally, the form requires documentation that attests to the applicant's current CPR credentials, completion of a state-approved course, and a valid National Registry of Emergency Medical Technicians (NREMT) card. Background disclosures are also a critical component, where applicants must disclose any past criminal offenses or licensing issues. The application process is designed to ensure that only qualified individuals are granted the privilege to serve Georgia's citizens in emergency medical situations, reflecting the state's commitment to public health and safety.

Sample - C 08 B Georgia Form

Initial EMT Certification Fee -
$
75*:
SSN
Last First
Birth Date
City State Zipcode ___________
Phone
Documentation attesting to current CPR credentials Proof of completion of a state approved course
NREMT Registry #
For ATP Applicants ONLY:
Do you hold any other license(s) or certificate(s)? __ Yes __ No
__ Yes __ No
Are there any criminal charges pending against you
?
__ Yes __ No
or been denied a certificate or license? __ Yes __ No
against you? __ Yes __ No
Have you ever voluntarily surrendered a certificate or license for any reason? __ Yes __ No
Have you ever had a certification, accreditation or professional healing arts license suspended, revoked
or placed on probation; and/or are you currently under investigation? __ Yes __ No
Copy of your Federal or State Government
Issued Photo Identification
CERIFICATIONS
Date IssuedCertificate/License NumberKind of Certificate/License and State of Issuance
EMT-Paramedic Applicants: Documentation
attesting to current ACLS credentials.
Passed Advanced Tactical Practitioner written
exam and hold current credentials.
EMS OUT-OF-STATE LICENSURE APPLICATION
GEORGIA STATE OFFICE OF EMERGENCY MEDICAL SERVICES AND TRAUMA
Form C-08-B
APPLICATION – PRINT IN INK OR TYPE
BASIC
Mail application
and required
documents to:
State Office of EMS and Trauma
ATTN: Personnel Licensure
2600 Skyland Drive - Lower Level
Atlanta, GA 30319
INTERMEDIATE 85
PARAMEDIC
______ - _______ - _________
County _______________
* The non-refundable fee must accompany this application. Payment must be in the form of Money Order, Business Check
or Cashier's Check Only. MAKE ALL FEES PAYABLE TO "GEORGIA DEPARTMENT OF PUBLIC HEALTH"
PERSONAL INFORMATION
Legal Name _______ - _____ - __________
All applications are processed within 5-7 business days from the date received.
Copy of current NREMT Wallet Card
Reinstatement Certification Fee
Lapse 2yr of Certification - $150*
_________________________
(______) _______ - __________ E-Mail ____________________________________________________
CERTIFICATION REQUIREMENTS - Applicant shall provide all listed information and/or documents
M.I.
Address
and/or remediation as a result of the action.
BACKGROUND DISCLOSURE
Have you ever been arrested and/or convicted of any National, Federal, State or Local felony and/or
If you answered yes to either of the above questions, attach a detailed written statement, signed and dated, describing the crime(s),
misdemeanor offense in Georgia or in any other state or place?
Have you ever been denied the privilege of taking an examination given by any state licensing board
date, location, court, sentence served, and parole, if any. Attach copies of all related records, court documents and police reports.
Congratulations! Your willingness to serve Georgia’s citizens as an EMS professional is appreciated!
Current NATIONAL CRIMINAL HISTORY REPORT generated
no earlier than twelve (12) months prior to submitting an
application for licensure that includes your name, birthdate and
at least part of your SSN. Internet searches meeting the above
criteria are accepted.
Have you ever resigned from any employment after a complaint or peer review action has been initiated
If you answered yes, attach a detailed written statement, signed and dated, describing the event, investigation, action, any corrective action,
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
GEORGIA DEPARTMENT
OF PUBLIC HEALTH
A
Division of Em ergency
Preparedn ess & Response
Date
City
State
Sworn to and subscribed before me this ______ day of ___________, 20_____.
My Commission Expires _______________________________
(SEAL)
FORM C-08-B: OUT-OF-STATE APPLICATION FOR LICENSE
____________________________________________________
Notary Public
Notary: DO NOT notarize this section
unless a passport photograph is
attached.
Name Of Applicant
AFFIDAVIT OF APPLICANT
GEORGIA OFFICE OF EMERGENCY MEDICAL SERVICES AND TRAUMA
Signature of Applicant
GEORGIA DEPARTMENT
OF PUBLIC HEALTH
A
Division of Em ergency
Preparedn ess & Response
I acknowledge and state that I have read and answered all questions in compliance with this application. I
acknowledge that it is my responsibility to read and become familiar with the Georgia Department of Public
Health Rules and Regulations for Emergency Medical Services 111-9-2.
I further state that by filing this application for a license in the State of Georgia, I hereby authorize and
consent to have an investigation made as to my moral character, professional reputation and fitness for
practice as an EMS provider. I agree to give any further information which may be required in reference to
my past record. I understand that I will not receive a copy of the report or know its contents and I further
understand that the content of the investigative report will be privileged, unless determined otherwise by the
Board or Court Order.
I hereby release, discharge, and exonerate the Georgia Department of Public Health, its agents,
representatives, and any person so furnishing information, from any and all liability of every nature and kind
arise out of the furnishing or inspection of such documents, records or other information or the investigation
made by the Georgia Department of Public Health. I authorize the Georgia Department of Public Health to
release information, material, documents, orders of the like relating to me or to this application to any othe
r
agency of the State of Georgia, the licensing agency of any other State or Territory of the United States o
r
Province of Canada, a law enforcement agency, a hospital, or other agencies determined by the Board.
This is to certify that the foregoing information is true and correct to the best of my knowledge. I understand
that any person who shall give false or forged evidence of any kind to the Board may be prosecuted to the
fullest extent allowed by law.
Attach Photo Here
Being duly sworn, says that he/she is the person who executed this application for licensure as an EMS provider in the
State of Georgia; and that all the statements herein contained are true in every respect and that the attached photo is a
true photo of applicant.
SSN:
Current Address:
I am requesting Georgia license based on the following current license(s) or certification(s):
___ in the state of __________________ AND by the National Registry of EMTs
Current certification(s) or license(s) in another state or issued by the National Registry of EMTs:
# _____________
_
# _____________
_
# _____________
_
# ______________
A.
__ Yes __ No
B. __ Yes __ No
C. __ Yes __ No
D. __ Yes __ No
Title:
State:
Date:
Date:
Date:
_
___/_____/20_____
_
License #
Exp Date:
Recv'd by:
_
________________
_
___________________
Type: __ M/O __ C/C __ B/C
(ATP, ACLS, etc)
____/_____/20______
Notes: ____________________________
___________________________________
___________________________________Other Certifications
Amount Recv'd: $ _____________
Course Completion
NREMT Card
CPR Credentials
Nat'l Criminal Background
DO NOT WRITE BELOW THIS LINE
(For OEMS Use Only)
Application Complete
Government Photo ID CH # ________________________
Application Documents Application Fee Certification Status
Status: __ Approved __ Denied
____/_____/20______
gency Name: _____________________________________________
Phone Number: ____________________________ Ext: ___________
_________________________
_________________________
_________________________
Do you know of any reason licensure in Georgia should be denied?
If yes, please explain ______________________________________________________________________
__________________________________________________________________________________________
Verifying Person’s Name: _____________________________________
policy?
Has the above certification(s) or license(s) ever been revoked or suspended?
If yes, what was the offense? _______________________________________________________________
Date of conviction ______________________ Place of conviction ________________________________
______________________________________________________________________________
PART II: Completed by the State Certifying Agency
Please assist by verifying that this individual is currently certified and in good standing according to your
If yes, please explain ______________________________________________________________________
Paramedic Certificate
Expiration Date ____________________
Expiration Date ____________________
Expiration Date ____________________
certification policies.
Is the above-referenced cited certificates(s) or license(s) deemed current and valid according to your
Other (specify) ______________________________________
EMT - Basic Certificate
EMT - Intermediate Certificate
license and/or certification you hold. Your application cannot be processed without this form.
PART I: Completed by Applicant
__________________________________________________________________________________________
Has the above listed individual ever been convicted of a felony?
______ - ______ - __________Legal Name: _______________________________________________
______________________________________________________________________________
__________________________________________________________________________________________
Expiration Date ____________________Certificate
GEORGIA OFFICE OF EMERGENCY MEDICAL SERVICES AND TRAUMA
LICENSE VERIFICATION FORM
are licensed or certified by another state. Please note that you must submit a separate form for each
This form is used to verify the good standing of EMT or paramedic license or certification applicants who
GEORGIA DEPARTMENT
OF PUBLIC HEALTH
A
Division of Em ergency
Preparedn ess & Response

Form Information

Fact Name Details
Form Title EMS Out-of-State Licensure Application
Governing Body Georgia Department of Public Health
Application Fees Initial EMT Certification Fee: $75; Intermediate: $85; Paramedic: $150 (non-refundable)
Submission Address 2600 Skyland Drive - Lower Level, Atlanta, GA 30319
Processing Time Applications are processed within 5-7 business days from receipt.
Required Documents Current CPR credentials, NREMT Wallet Card, Federal or State ID, and National Criminal History Report.
Background Disclosure Applicants must disclose any arrests or convictions and provide details if applicable.
Notary Requirement Application must be notarized only if a passport photograph is attached.

Detailed Guide for Filling Out C 08 B Georgia

To complete the C 08 B Georgia form for out-of-state licensure, follow these steps carefully. Ensure that all required information is accurate and complete. Once the form is filled out, it will be submitted to the Georgia Department of Public Health along with the necessary fees and documents.

  1. Obtain the form: Download or print the C 08 B form from the Georgia Department of Public Health website.
  2. Fill in personal information: Provide your legal name, Social Security Number (SSN), address, birth date, city, county, state, zip code, phone number, and email address in the designated sections.
  3. Choose the certification type: Indicate whether you are applying for Basic, Intermediate, or Paramedic certification by checking the appropriate box.
  4. Prepare required documentation: Gather all necessary documents, including CPR credentials, proof of course completion, NREMT wallet card, government-issued photo ID, and a national criminal history report.
  5. Complete certification requirements: Answer questions about any other licenses or certifications you hold, as well as any criminal history or employment issues. Attach detailed statements if applicable.
  6. Sign the affidavit: Read the affidavit section carefully. Sign and date it to confirm that all information provided is true and accurate.
  7. Attach a photo: Include a recent passport-sized photo in the designated area on the form.
  8. Prepare payment: Include a money order, business check, or cashier's check for the appropriate fee, made payable to "Georgia Department of Public Health."
  9. Submit the application: Mail the completed form, along with all documents and payment, to the address specified on the form: Georgia State Office of EMS and Trauma, 2600 Skyland Drive - Lower Level, Atlanta, GA 30319.

After submission, the application will be processed within 5-7 business days. It is important to ensure that all information is accurate to avoid delays in the licensure process.

Obtain Answers on C 08 B Georgia

  1. What is the purpose of the C 08 B Georgia form?

    The C 08 B form is an application for out-of-state licensure for Emergency Medical Technicians (EMTs) in Georgia. It is specifically designed for individuals who are seeking to obtain licensure to practice as EMTs in Georgia while holding a certification or license from another state.

  2. What fees are associated with submitting the C 08 B form?

    Applicants must pay a non-refundable fee when submitting the form. The fees are as follows:

    • Initial EMT Certification Fee: $75
    • Intermediate Certification Fee: $85
    • Reinstatement Certification Fee: $150 (if the certification has lapsed for two years or more)

    Payments must be made via money order, business check, or cashier's check, and should be made payable to the "Georgia Department of Public Health."

  3. What personal information is required on the application?

    Applicants must provide their legal name, Social Security Number (SSN), address, birth date, phone number, and email address. This information is essential for processing the application and verifying the applicant's identity.

  4. What documents must be submitted with the application?

    Along with the completed application form, applicants need to submit several documents, including:

    • Current CPR credentials
    • Proof of completion of a state-approved EMT course
    • Copy of the current National Registry of Emergency Medical Technicians (NREMT) wallet card
    • Issued photo identification
    • National criminal history report

    For EMT-Paramedic applicants, documentation attesting to current Advanced Cardiac Life Support (ACLS) credentials is also required.

  5. What should I do if I have a criminal record?

    If you have ever been arrested or convicted of a felony or misdemeanor, you must answer "yes" to the relevant questions on the application. You will need to attach a detailed written statement describing the crime, including the date, location, court, and any sentences served. Copies of related records and documents should also be included.

  6. How long does it take to process the application?

    All applications are processed within 5 to 7 business days from the date they are received. It is important to ensure that all required documents and fees are submitted to avoid delays in processing.

  7. What happens after my application is approved?

    Once the application is approved, the applicant will receive a license to practice as an EMT in Georgia. This licensure allows the individual to serve the community as an EMS professional, contributing to public health and safety.

  8. Is there an affidavit that needs to be signed?

    Yes, the application includes an affidavit where the applicant acknowledges that they have read and answered all questions truthfully. The applicant also consents to an investigation of their moral character and professional reputation as part of the licensing process.

Common mistakes

Completing the C 08 B Georgia form is a crucial step for those seeking out-of-state licensure as an EMS provider. However, many applicants make common mistakes that can delay the processing of their application. Understanding these pitfalls can save time and ensure a smoother application experience.

One frequent error involves the payment method. The application requires fees to be paid via money order, business check, or cashier's check. Many applicants mistakenly send personal checks or cash, which can lead to immediate rejection of the application. It is essential to follow the specified payment instructions closely to avoid such issues.

Another common mistake is providing incomplete personal information. Applicants often forget to fill in critical details, such as their Social Security Number or contact information. Missing information can halt the processing of the application, so double-checking all fields before submission is advisable.

Some individuals neglect to include the necessary documentation that supports their application. This includes proof of CPR certification, NREMT wallet card, and a national criminal history report. Failing to attach these documents can result in delays or outright denial of the application. Ensuring that all required documents are included is vital for a successful submission.

In addition, applicants sometimes overlook the importance of background disclosure. Failing to disclose past criminal history or disciplinary actions can lead to serious consequences, including potential legal ramifications. It is better to be transparent and provide a detailed statement if any such issues exist.

Moreover, some applicants forget to sign and date the affidavit section of the application. This step is crucial, as it confirms the accuracy of the information provided. An unsigned application may be considered incomplete, leading to further delays.

Another mistake is the failure to follow instructions regarding notarization. The application clearly states that the notary should not sign unless a passport photograph is attached. Ignoring this requirement can complicate the process, as the application may be returned for correction.

Some applicants also misinterpret the section about holding other licenses. They may either fail to disclose additional licenses or provide insufficient details about them. Complete and accurate reporting of all certifications is essential to avoid complications in the review process.

Finally, many people underestimate the importance of timeliness in submitting their application. The process can take 5-7 business days, but delays can occur if the application is incomplete or incorrect. Submitting the application well in advance of any deadlines is a wise strategy.

By being aware of these common mistakes, applicants can navigate the C 08 B Georgia form with greater ease and confidence. Attention to detail and adherence to instructions are key components of a successful application process.

Documents used along the form

The C 08 B form is essential for individuals seeking licensure as Emergency Medical Technicians (EMTs) in Georgia. Alongside this form, several other documents are typically required to ensure a complete application. Below is a list of these documents, each playing a crucial role in the licensure process.

  • National Criminal History Report: This report provides a comprehensive background check, verifying whether the applicant has any criminal history. It must include the applicant's name, birthdate, and part of their Social Security number.
  • CPR Credentials: Proof of current CPR certification is necessary. This demonstrates that the applicant has the skills to perform cardiopulmonary resuscitation, a critical life-saving technique.
  • NREMT Wallet Card: A copy of the National Registry of Emergency Medical Technicians (NREMT) wallet card is required. This card confirms the applicant's certification status and is a vital credential for EMTs.
  • Course Completion Certificate: Documentation showing successful completion of a state-approved EMT training course is essential. This certificate verifies that the applicant has met the educational requirements for licensure.
  • Government-Issued Photo ID: A valid photo identification issued by a federal or state government is necessary for identity verification. This helps ensure that the application is submitted by the correct individual.
  • Affidavit of Applicant: This document is a sworn statement where the applicant acknowledges the accuracy of the information provided in the application. It also grants permission for the Georgia Department of Public Health to conduct a character investigation.

These documents collectively support the C 08 B form, helping to establish the qualifications and background of applicants. Properly completing and submitting these forms is crucial for a smooth licensure process in Georgia.

Similar forms

The C 08 B Georgia form is an application for out-of-state licensure for Emergency Medical Services (EMS) professionals. Several other documents serve similar purposes in various contexts. Here are six documents that share similarities with the C 08 B form:

  • National Registry of Emergency Medical Technicians (NREMT) Application: Like the C 08 B form, this application is essential for individuals seeking certification as EMTs or paramedics. Both require proof of training and background checks.
  • State EMT License Application: This form is used to apply for an EMT license within a specific state. Similar to the C 08 B, it requires personal information, proof of training, and may include a criminal background disclosure.
  • Paramedic Certification Application: This application is for those seeking paramedic certification. It mirrors the C 08 B form by necessitating documentation of training and certifications, as well as a background check.
  • Criminal Background Check Form: This document is often required alongside applications like the C 08 B to assess the applicant's criminal history. Both forms emphasize the importance of transparency regarding any past offenses.
  • Affidavit of Eligibility: Used in various licensing processes, this affidavit confirms that the applicant meets all eligibility requirements. It aligns with the C 08 B in ensuring that the applicant is truthful about their qualifications and background.
  • Verification of Licensure Form: This form is similar in purpose to the C 08 B as it verifies the good standing of an applicant's existing licenses. Both documents require confirmation from the issuing authority about the applicant's current status.

Each of these documents plays a crucial role in ensuring that EMS professionals meet the necessary standards for practice and maintain the safety and well-being of the communities they serve.

Dos and Don'ts

When filling out the C 08 B Georgia form, there are important guidelines to follow. Here’s a list of things you should and shouldn't do:

  • Do print clearly in ink or type your responses.
  • Do ensure all personal information is accurate and complete.
  • Do include all required documentation with your application.
  • Do pay the correct application fee using a money order, business check, or cashier's check.
  • Do sign and date the affidavit of applicant section.
  • Don't leave any questions unanswered; provide explanations where necessary.
  • Don't forget to attach a recent photo if required.

Following these guidelines will help ensure your application is processed smoothly.

Misconceptions

  • Misconception 1: The C 08 B form is only for new applicants.
  • This form is actually designed for both initial certification and reinstatement of licensure. If someone has previously held a license that has lapsed, they can use this form to apply for reinstatement as well.

  • Misconception 2: Payment methods for the application fee are flexible.
  • In reality, the application fee must be paid using specific methods. Acceptable forms include a money order, business check, or cashier's check only. Personal checks are not accepted, which is a common misunderstanding.

  • Misconception 3: Background disclosures are optional.
  • Many people believe that answering background questions is optional. However, providing accurate information about any arrests or convictions is mandatory. Failure to disclose this information can lead to denial of the application.

  • Misconception 4: All applications are processed immediately.
  • Applicants often think that their applications will be processed right away. In fact, the processing time typically ranges from 5 to 7 business days from the date the application is received.

  • Misconception 5: Only EMTs can use this form.
  • This form is not limited to EMTs. It is applicable to various levels of emergency medical service providers, including paramedics and advanced tactical practitioners. Each category has specific requirements that must be met.

Key takeaways

Filling out and using the C 08 B Georgia form for out-of-state licensure as an EMS provider requires careful attention to detail. Here are some key takeaways to guide you through the process:

  • Complete the Application Accurately: Ensure that all personal information, including your legal name, address, and Social Security Number, is filled out accurately. Any discrepancies can lead to delays.
  • Understand the Fees: The application requires a non-refundable fee, which varies based on your certification level. Payment must be made via money order, business check, or cashier's check.
  • Gather Required Documentation: You must provide proof of current CPR credentials, a copy of your NREMT wallet card, and other relevant certifications. Make sure these documents are up-to-date.
  • Criminal Background Disclosure: Be prepared to disclose any arrests or convictions. If applicable, attach a detailed statement regarding the circumstances, including court documents.
  • Licensure Verification: If you hold licenses from other states, complete the license verification form. This step is crucial for ensuring your application is processed smoothly.
  • Be Mindful of the Processing Time: Applications are typically processed within 5-7 business days. Plan accordingly to avoid any interruptions in your licensure status.
  • Read the Affidavit Carefully: The affidavit section requires your acknowledgment of the application’s accuracy and your consent to a background investigation. Take this seriously, as it impacts your licensure.
  • Attach a Recent Photo: A passport-sized photo must accompany your application. Ensure it is properly attached, as failure to do so can result in your application being rejected.

By following these key takeaways, you can navigate the C 08 B Georgia form process more effectively, ensuring that your application for EMS licensure is complete and compliant with state requirements.