UKREMT Application Form

UKREMT REGISTRATION APPLICATION

All application data is GDPR & HIPAA Compliant
We no longer do Free ID Cards or Certificates.

The free UKREMT application comes thanks to GWAS Ambulance Charity who are supporting a "free for all" voluntary registration scheme for all those working in pre-hospital care.

On the new UKREMT website there will be a shop to buy a physical ID card should you require one - all funds raised from ID card sales help the chairty run the UKREMT as a free for all registration scheme.

We are the only free prehospital care scheme in the UK.
APPLICANT INFORMATION
Full Name*

PrefixFirst NameLast Name
Date of Birth

DDMMYYYY
Address

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
ID Attached *

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Photo ID (NHS or Company ID, Passport or Driving Licence) Cancelof
Attach Head Shot Photo*

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Required for upcoming photo ID Cancelof
Mobile Number*

07427123456
E-mail*
Type of registration applying for?*
Corporate registrations please email
Grade applied for:
Please leave blank if unsure

PRE-HOSPITAL CARE QUALIFICATIONS
Highest Pre-Hospital Care Qualification?*
All qualifiactions will be audited 100% - please ensure its attached below.
Highest qualification attached:*

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You can upload multiple files and certificates. Cancelof
For grade F (EMT 3) AAP, FREUC 5, IHCD TECHNICIAN please confirm you meet all standards on PHEC pathway and that you have completed your 750hrs supervised clinical practice. (Legal Requirement)*

750 Hours CompletedIn Process of sign offNo, Course qualified onlyOther
Other Pre-Hospital Care Qualifications and/or extended skills:
Via Certification or CPD (all listed qualifications must be 100% checkable. please attach below)
Other additional qualifications if not already attached.

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You can upload multiple certificates - please ensure the name of the file matches the cert to help our auditors. Cancelof
All above listed "Other Pre-Hospital Care Qualifications" if they have not been upload then please indicate if being sent via seperate email to ukremt@ukremt.org (if not sent or uploaded, we can not use them as evidence - as they can't be audited).*

YES - Sent via seperate emailNO - Included in attachmentsNo additional qualifications

Evidence - CPD, CV and further information requirements
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 Record attached:

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Please attache evidence of your CPD - only evidenced CPD can be audited. For EMT2 and above failure to evidence 36hrs CPD will mean you will be downgraded to EMT1. Cancelof
Curriculum Vitae (CV) Attached:*
Adding your CV helps us to audit quicker and aids in ensuring the correct grade is allocated.
CV:

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Please remember to attach your CV in Doc, PDF or JPEG format. Cancelof
DRIVING:
Driving Licence Number*
Copy of Driving Licence*

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Please attach a photo of both sides of your licence in JPEG, DOC or PDF Cancelof
Blue Light Driving Qualification:*
Name of qualification (If not held please state - none) Note: IAM or ROSPA Adv Driving in itself is not a blue light qualification.
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

REFERENCES & DBS
Please supply up to 2 references, we require at least 1 work (can be instructor, employer or client) reference to move forward on your applicaiton.
Name of Reference 1:*
Connection / How known to applicant?*
Email address of reference:*
example@example.com
Name of Reference 2:
Connection / How known to applicant?
Email address of reference:
example@example.com
DBS Certificate No.*
Please enter your Enhanced DBS number (we do not accept a Basic check)
Registered for the DBS gov update service?
DBS Certificate Attached:*

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FAILURE to attached your last Enhanced DBS will mean your application is rejected with no refunds. Cancelof
If you do not have an Enhanced DBS and would like the UKREMT to apply for one for you please note this can be done for a fee of £90.00 please send a seperate email to DBS@ukremt.org with the subject line UKREMT DBS Application. You will require an Enhanced DBS either attached or applied for, for your application to be processed as per our FTP. We do of course accept Scottish Disclosure as well as for overseas registrants a local police certificate of good standing or similar.

SIGNATURE
Any additional information you feel would enhance your application please feel free to add it below or send this in a sperate email - with the subject line "Additional Application Information" to ukremt@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*
Admin Approval
PIN Number
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.

Applications can take up to one month to process, please do not contact us for at lease 30 days in relation to this application.
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UKREMT REGISTRATION APPLICATION