In the state of New York, the Department of Health has instituted a specific form, known as the DOH 3312, that plays a crucial role in the verification process for members of the Emergency Medical Services (EMS) agencies operating within the state. This document serves as a mandatory verification of membership for individuals seeking either initial certification or recertification as part of a New York State EMS agency. It requires detailed information to be filled out accurately and legibly, including the applicant's identification details, EMS Identification Number (if already assigned), and the agency code for both primary and secondary EMS agencies where applicable. The form insists on the official affirmation from a representative of the primary EMS agency to confirm the applicant's current membership and warns against the provision of false information; highlighting the legal consequences that could ensue. Completion and submission of this form to the Course Sponsor prior to the end of the relevant course underscore its importance in the certification process for New York's EMS personnel, ensuring that only verified members are able to proceed towards certification or recertification, thereby maintaining the integrity and reliability of emergency medical services across the state.
| Question | Answer |
|---|---|
| Form Name | Doh 3312 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | verification nys ems, 3312 form, 3312 ems, 3312 |