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Current Resource Hospital: Advocate BroMenn Medical Center

Online System Entry Form 

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Have you ever been suspended from an EMS System?
Are you currently suspended from an EMS system?
Are you currently or have you ever worked in another EMS System?
Have you ever been convicted of a felony?
Are you currently charged with a felony or have pending felony charges?
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EMT License Upload
Max File Size 15MB

EMS License

Drivers License Upload
Max File Size 15MB

Drivers License

CPR Card
Max File Size 15MB

CPR Card

Misc. Cards
Max File Size 15MB

Misc Cards

If you are able to, please submit copies of licensure in above box. Note you may only submit one document per box. 

If possible, submit copies of license in one document and save as a PDF if possible. 

Are you currently the subject of any pending investigations by IDPH or a former system?

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing system entry, or for removal from the system should I be accepted into the system. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for system entry. I also authorize you to request and receive such information. 

I,                                                                                              do hereby understand and agree to the MCAMES system entry policy as outlined in the system policy manual.  I have been given the opportunity to ask any questions I have regarding the policy and expectations of me within the system to a system representative.  I understand that privileges to function within the McLean County Area EMS System are completely at the professional discretion of the EMS Medical Director and/or designee. I also understand that my current status in the system entry process will be shared freely with the administration of my sponsoring agency.

Please enter your first, middle and last initial plus the last four numbers of your social security as a signature. (Example: AAA1234). By entering that above, this constitute as a signature.

Once the above is completed, please click submit button below. Note that submission of the online form does not guarantee acceptance into the MCAEMS System. All testing (if applicable) needs to be completed. Once all paperwork is submitted and testing completed, a letter of system approval will be sent to your sponsoring agency. 

You MAY NOT respond to calls until officially approved by the EMS System. 

Once the above is completed, please click submit button below. Note that submission of the online form does not guarantee acceptance into the MCAEMS System. All testing (if applicable) needs to be completed. Once all paperwork is submitted and testing completed, a letter of system approval will be sent to your sponsoring agency. 

You MAY NOT respond to calls until officially approved by the EMS System.