Form EMS-38 "Staff Roster" - New Jersey

What Is Form EMS-38?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2012;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form EMS-38 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form EMS-38 "Staff Roster" - New Jersey

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New Jersey Department of Health
STAFF ROSTER
Office of Emergency Medical Services
Please Print or Type
Instructions:
Print your services full trade name (as it appears on your vehicle and today’s date in the box below.
Print the full name of every person who will staff any of your vehicles.
Print the required information for each person, including social security number and course/expiration dates.
Make additional copies of this blank form as needed
Trade Name of Service (exactly as it appears on your vehicles):
Drivers
Ambulance Staff
MAV Staff
Staff Person
License
CPR
MAVT
CPR
(Last Name, First Name)
Expiration
EMT ID Number and Exp. Date
Expiration
Cert. (Exp.)
Expiration
Date
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EMS-38
JUL 12
Page 1 of 2 Pages.
New Jersey Department of Health
STAFF ROSTER
Office of Emergency Medical Services
Please Print or Type
Instructions:
Print your services full trade name (as it appears on your vehicle and today’s date in the box below.
Print the full name of every person who will staff any of your vehicles.
Print the required information for each person, including social security number and course/expiration dates.
Make additional copies of this blank form as needed
Trade Name of Service (exactly as it appears on your vehicles):
Drivers
Ambulance Staff
MAV Staff
Staff Person
License
CPR
MAVT
CPR
(Last Name, First Name)
Expiration
EMT ID Number and Exp. Date
Expiration
Cert. (Exp.)
Expiration
Date
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EMS-38
JUL 12
Page 1 of 2 Pages.
STAFF ROSTER, Continued
Trade Name of Service (exactly as it appears on your vehicles):
Drivers
Ambulance Staff
MAV Staff
Staff Person
License
CPR
MAVT
CPR
(Last Name, First Name)
Expiration
EMT ID Number and Exp. Date
Expiration
Cert. (Exp.)
Expiration
Date
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EMS-38
JUL 12
Page 2 of 2 Pages.
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