West Custer County Medical Center | Custer County Clinic

An Equal Opportunity Employer

Personal Information
Name*
First Middle Last
Present Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is your physical address different than your mailing address above?*
- Yes
- No
Present Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email Address*
Employment Desired
Position for which you are applying*
Are you employed now?*
- Yes
- No
Have you ever applied to the West Custer County Hospital District before?*
- Yes
- No
Education
Education History*
Click plus icon to include additional schools.
Name of School Location of School Number of Years Attended Did You Graduate? Major or Subjects Studied
General
Subjects of Special Study or Work
Special Skills
Former Employers
Number of Employers
Employment History*
List your last four (4) employers, starting with the most recent.
Starting Date Ending Date Name of Employer Address of Employer Phone of Employer Salary Position Reason for Leaving
References
Professional References*
Please provide four (4) professional references. May substitute two (2) personal references.
First Name Last Name Company Name Phone Number Relationship to You
Consent and Agreement
I certify that all of the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected or, if I am employed at the time of discovery, my employment may be terminated.
In consideration of my employment, I agree to conform to the company's rules and regulations and, I agree that my employment and compensation can be terminated with or without cause and with or without notice at any time at either my or the West Custer County Hospital District options. I also understand and agree that the terms and conditions of my employment may be changed with or without cause and with or without notice at any time by the West Custer County Hospital District. I understand that no company representative, other than it's administrator, and then
You must agree to the above statement before submitting this application*
- I understand and agree to the above statement
CAPTCHA

Custer County Emergency Medical Services is looking for a team oriented person to join our crew as our new EMS Administration Specialist. This position is estimated at 16 – 24 hours per week. Duties will include ambulance billing, accounts payables & receivables, payroll, organizing & maintaining schedules, supply ordering and other daily administrative duties. Experience in a medical office, or EMT-B preferred. Please apply at www.custercountymedicalcenter.com, or call (719) 783-0447 for information.

Name of School	Location of School	Number of Years Attended	Did You Graduate?	Major or Subjects Studied

Starting Date	Ending Date	Name of Employer	Address of Employer	Phone of Employer	Salary	Position	Reason for Leaving

First Name	Last Name	Company Name	Phone Number	Relationship to You

Personal Information

Employment Desired

Education

General

Former Employers

References

Consent and Agreement