UKREMT Application Form

UKREMT RE-REGISTRATION

All application data is GDPR & HIPAA Compliant
You will get sent out once your renewal application is processed the following:

Digital Secure Photo ID Card

PDF UKREMT Registration Certificate
REGISTRANT INFORMATION
Full Name*

PrefixFirst NameLast Name
EMT Pin Number:*
Starts Em00...
Date of Birth*

DDMMYYYY
ID Attached *

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Photo ID (NHS or Company ID, Passport or Driving Licence) Cancelof
Failure to attach ID will mean your renewal application is put on hold until we receive it.

Note: If you have used the front of your Driving Licence as ID, we still need you to attach the rear image below as part of our checks on Identification & your licence number in the relevant box. If you have not used your driving licence as ID above please add images of both sides below.
Driving Licence Number:*
Please enter your licence number
Driving Licence Image:*

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Please attach a file or multiple files that show the front and back of your licence (JPEG, DOC or PDF) Cancelof
PHOTO (Head Shot)*

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Required for issue of UKREMT Photo Id Card which will be Free with renewal. Cancelof
We need a full correct CURRENT address & email to ensure your renewal pack reaches you via post, email address is to ensure we can correspond with you quickly at all times about your registration and changes that may happen.
Provide Current Address*

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
E-mail*
Mobile Number*

Country CodeArea CodePhone Number
Type of registration currently hold*

Renewall Registration Payment*

FULL Registration(£22.50 for each year)

3 Year Renewal

ASSOCIATE Registration(£22.50 for each year)

3 Year Renewal

OVERSEAS Registration(£45.00 for each year)

3 Year Renewal

Enter coupon

Total £0.00

CONFIRMATION OF PRE-HOSPITAL CARE QUALIFICATIONS
Highest Pre-Hospital Qualification:*
I confirm that my current highest (base) qualification remains as at first registration or as per a previous upgrade for sent during my last period of registration.

I confirm that i will submit with this document pages 15/16 of the FTP policy regardless of whether i have done so already on first application (must be submitted every two years).

I confirm that i have undertaken the required level of CPD in the last 2 years and that I continue to uphold the values and aims of the UKREMT.
Please sign the above statement

Clear
No. of hours of claimed CPD in last 12 months:*
For grades E and above i.e EMT2 and above you must evidence 36hrs of CPD (if zero please state 0)
CPD Evidence Upload*

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Upload all your relevant CPD... (Multiple files can be added) Only evidenced CPD can be audited. Cancelof
Upgrade to grade / EMT level requested
Choose Yes / No
Upgrade to EMT (?) reguested
Please select level to upgrade to?
CV:

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Please remember to attach your CV in Doc, PDF or JPEG format if you are asking for a grade upgrade. Cancelof
Please attache proof of new qualification / skills to EMT level of upgrade

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If you have since last registration or upgrade gained your Blue Light Driving Qualification:
Name of qualification (If no change since last registration please leave blank)
Date Achieved:

DayMonthYear
Date (DD-MM-YYYY)
Blue Light Qualification Attached:

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Please submit in Doc, Docx, PDF, JPG, JPEG, PNG or HTML Cancelof

TERMS & CONDITIONS / FITTNESS TO PRACTICE
Please agree to application T&Cs to continue application:*

1. Agree for registration** to be made public on the UKREMT website (** PIN. Name, Qualification, EMT Level & Grade as well as Blue Light Qualification and the Registration expiry date, only - unless T&Cs 4 or 5 are applicable)2. Agree to read, sign and abide by the Fitness To Practice policy document as a condition of registration (Downloadable from the UKREMT website at www.ukremt.org/fitnesstopractice) FTP Pages 15 & 16 will need to be attached to this application.3. Agree to abide by the EMT Code as put forward by the UKREMT which can be found on our website (www.ukremt.org).4. Agree that if a concerned is raised the UKREMT has the right to show this concern as a suspension for up to 12 months or a period not exceeding your current registration period which ever is sooner at this point either reinstatment or a strike order will be applied to your registration.5. Agree that if you are struck off by the UKREMT that your name will show on the database of registrants as having been struck off - these details will remain visible for a period not exceeding your current registraion period.6. Agree to pay all your own fees (legal and otherwise) in relation to both this application and ongoing registration this includes and appeals or fitness to practice hearings.7. Agree under GDPR to recieve emails from UKREMT in relation to your application and registration and agree that we can share applicant details with third parties in relation to due dilligence checks and FTP investigations..8. If during as part of the FTP policy or during an application, if a registrant or applicant is believed to be committing an offence or we suspect a safeguarding concern then you agree we can share all details with the police and other third parties to safeguard the public.
Signed Fitness To Practice (FTP) is attached:*

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Pages 15 & 16 Only required FAILURE to attach a signed FTP will mean your application is rejected. Cancelof

DBS
DBS Certificate No.*
Please enter your DBS number
Registered for the DBS gov update service?
DBS Certificate Attached:*

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FAILURE to attached your last DBS will mean your application is rejected. Cancelof
If you do not have a DBS and would like the UKREMT to apply for one for ou please note this can be done for a fee of £59.00 please send a seperate email to DBS@ukremt.org with the subject line UKREMT DBS Application. You will require a DBS either attached or applied for, for your application to be processed as per our FTP.

SIGNATURE
Any additional information you feel would enhance your re-registration application please feel free to add it below or send this in a sperate email - with the subject line "Additional Re-Registration Information" to info@ukremt.org.
Additional Information:
I authorised the verfication of tall the information on this form, for UKREMT audit team to verify my details for registration and FTP.
Signature Name*

First NameLast Name
Signature*
By submitting this form you agree that all the information contained in it, is accurate to the best of your knowledge and accept that a submission is made regardless of if form is signed and the submission itself will be accepted as your electronic signature.
Should be Empty:

UKREMT RE-REGISTRATION