Directions for Completion of Fingerprint Background Check
EMT Certification/Recertification Applicants
1. Obtain a “Request for Live Scan Service” form from the EMS Agency. You can pick up a form at the EMS Agency or use the following link:
The background check process must be completed for each Agency that requires one. Information obtained in a DOJ/FBI Background Check cannot be shared between Agencies.
2. Complete the fields listed below (please see attached sample form):
- ORI: A2014
- Type of Application: Emergency Med Tech/Cert
- Job Title or Type of License, Certification or Permit: Mountain-Valley EMS Agency
- Agency authorized to receive criminal history information: Mountain-Valley EMS Agency
- Mail Code (five digit code assigned by DOJ): 07792
- Street No. Street or P.O. Box: 1101 Standiford Avenue, Suite D-1
- Contact Name: Cindy Murdaugh
- City: Modesto
- State: CA
- Zip Code: 95350
- Contact Telephone No.: 209-529-5085
- Name of Applicant: Enter your last name, first name and middle initial
- Alias: Enter any other names you’ve used
- Driver’s License No.: Enter your California Driver’s License number
- Date of Birth: Enter your date of birth
- Sex: Check the appropriate box
- Height: Enter your height (feet and inches)
- Weight: Enter your weight
- Eye Color: Enter your eye color
- Hair Color: Enter your hair color
- Place of Birth: Enter your place of birth
- SOC: Enter your social security number
- Home Address: Enter your home street address, city, state and zip code
- Level of Service: Check the DOJ AND the FBI box
DO NOT COMPLETE ANY OTHER FIELDS ON THE FORM!
(If the form is filled out incorrectly, DOJ may reject it, requiring the background check to be repeated, including additional fees.)
3. Please have the Live Scan process completed within thirty (30) days prior to the date you plan on applying for certification or recertification. Contact a Live Scan Agency from the attached list and make an appointment, if necessary. Locations of Live Scan agencies in other counties can be found on the internet at http://www.ag.ca.gov/fingerprints/publications/contact.pdf
4. The total fee for the background check varies depending on where you have it done (please see attached list for fees) Each Live Scan agency charges a “rolling fee” which varies by agency. In addition to the Live Scan Agency’s rolling fee, there is a $32 Department of Justice (DOJ) and a $19 FBI non-refundable fee. You pay the total of the rolling fee, DOJ and FBI fee to the Live Scan Agency when you submit your fingerprints. Be sure to confirm what they accept as methods of payment (personal check, money order, cash, or credit card). Each Live Scan Agency may accept something different. When you choose where to go for your fingerprinting, it would be a good idea to call them, even if they don’t require appointments, to make sure you have all of the latest information for the particular Live Scan site.
5. You will need to take a photo I.D. with you to the Live Scan Agency.
6. Certification will be issued after review and approval of the application and associated documentation, results of the background check and receipt of the EMTI certification/recertification fee.
For LiveScan locations, go to http://ag.ca.gov/fingerprints/publications/contact.php