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New Medic - Entry to Practice Form (Service)

Paramedic Entry to Practice Request Form

Applicant Information

Full Name(*)
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Address(*)
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City(*)
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Province(*)
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Postal Code(*)
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EHS No
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Home Phone#(*)
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Cell Phone#
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Email Address(*)
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Applicant History

Education History

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Select your certification program

College Name
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City and Province
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Phone
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Program Title
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Graduation Date
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College Name
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City and Province
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Phone
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Program Title
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Graduation Date
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Have you been certified by one or more Ontario base hospitals to perform controlled acts in the last five years?(*)
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Base Hospital where you were previously certified to perform controlled acts
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Release of Information

I authorize the release of the information provided above to the Regional Paramedic Program for Eastern Ontario, via my employer and/or college. I authorize my employer and/or college to discuss my case with the RPPEO and to retain a copy of this form on file.(*)
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Paramedic Service or College:

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Deputy Chief's Name(*)
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Requested Certification Session Date(*)
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Certification History

I attest that the information contained herein is factual, that this individual meets all of the requirements for certification to perform controlled acts as outlined in Ontario Regulation 257/00, and that my service holds copies of the following documents pertaining to this individual:

CPR Certificate
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CRP Certification Date
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PCP Program Diploma
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Date Issued
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AEMCA
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Issue Date
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ACP Program Diploma
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Issue Date
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Ontario ACP Certificate
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Date Issued
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By clicking submit I am confirming that all information entered is correct and may be used in accordance with the terms of employment agreed upon at the beginning of my employment.

Tags: Service, new medic

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  • @RPPEO

    Spring CME launches on May 12 BUT paramedics can get a head start by participating in live virtual workshops for up to 4.5 hrs of CME credit on May 4, 5 and 6. You've gotta register for the live workshops! Read on: rppeo.ca/communications…

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    We're featuring paramedics who are experts in some important fields for Spring 2021 CME. RPPEO paramedics can participate in these LIVE Virtual Workshops. Registration is necessary and spots are limited. Visit rppeo.ca/communications…

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    Our ACPs may participate in live virtual workshops for Spring CME credit! We're excited about @IanR_Drennan's opening workshop that'll look at the latest cardiac arrest guidance on May 4 10:30-11:30. Space is limited: register now at rppeo.ca/paramedic-serv…

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    April showers bring May CME with the option for RPPEO paramedics to attend LIVE virtual workshops May 4, 5, 6! Register NOW rppeo.ca/communications…

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