Declaration of U.S. Citizenship Information
The Beason-Hammon Alabama Taxpayer and Citizen Protection Act requires every person or sole proprietorship applying for certain licenses or permits to either demonstrate U.S. citizenship, or, if the person is an alien, to prove lawful presence in this country. The Alabama Department of Public Health will verify an applicant’s immigration status or naturalized/derived citizenship status using the SAVE Program effective August 1, 2016.
To comply with this law, ADPH requires the following for an initial permit or renewal application:
- A signed Declaration of U.S. Citizenship or Lawful Presence of an Alien
- A legible photocopy or digital copy of a document demonstrating U.S. citizenship or lawful presence in the U.S.
A business entity must provide a Declaration of Business Ownership Structure if the type of ownership or business entity is not clearly indicated on the application.
ADPH will only verify the status of the individual who is licensed or permitted. Demonstration of U.S. citizenship or lawful permanent residence is only required one time.
- EMS Personnel License Requirements - Please read this document before filling out the application.
- EMS Individual Licensure Application - Complete the application and if you are a first issue, you must complete the Criminal History Information Release Form.
- EMS Provider Licensure Application- All plans and proof of liability insurance must accompany application. This form is fillable and should be typewritten not handwritten.
- Critical Care Paramedic Application - Complete this document and submit it with the Individual Licensure Application.
- Critical Care Provider Application - Complete this document and submit it with the Provider Licensure Application.
EMS Protocol Forms
- Chest Decompression Report
- Request to be Taken to a Hospital on Diversion
- Thrombolytic Checklist - STEMI
- Thrombolytic Checklist - Stroke
- Ambulance Accident Form - If you ambulance is involved in an accident, please submit this form to the OEMS.
- Alabama Portable Physician Do Not Attempt Resuscitation (DNAR) Order
- If you are an EMSP program requesting an Advanced Level National Registry Exam, please complete the request form and email it to Chris Hutto.
Page last updated: November 21, 2017