British Columbia Application for Emergency Medical Assistants (EMA) Licence Renewal

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PART A: Application Information

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Date of Birth
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Missing or incorrect valueNote: As indicated by Statistics Canada, transgender, transsexual, and intersex individuals should indicate the sex (male or female) with which they most associate themselves.
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PART B: Licence Requested

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PART C: Employment Information if applicable, are you currently employed?

Employment information is only required to be completed for all the employers for whom you plan to use your EMA licence.

Please choose at least one employer from the drop-down lists.

If you are not employed, please choose "K001 - NOT EMPLOYED" and if your employer does not appear on the list please choose "K002 - OTHER" and add the employer below.

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PART D: Acknowledgements and Declarations

As an applicant to the Board, I acknowledge that:
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Application Date

Personal information on this form is collected by the EMA Licensing Board under the authority of the Freedom of Information and Protection of Privacy Act Section 26(c) Emergency Health Services Act (section 6) and the Emergency Medical Assistant Regulation (sections 2, 3, 4, 9.2, 10 and 26). This information will be used to issue an EMA licence and maintain a permanent register of licensed EMA's. If you have any questions about the collection of this information contact our office at PO Box 9625 Stn Prov Govt, Victoria B.C., V8W 9P1, phone 250 952-1211. This information is protected from unauthorized use and disclosure in accordance with the Freedom of Information and Protection of Privacy Act and may be disclosed only in accordance with that Act.
HLTH 9702 Rev. 2024/09/27
a907791c492a3a5753eac0de9eec7b54dd61f203
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