719-589-3658Contact Us Now

Valley-Wide Health Systems Medical Clinics are open and seeing all patients. We also have telehealth appointments available for most healthcare needs. Please call 719-589-3658 to get started.

Click here to visit our COVID-19 Updates page.

Application Form

Application Form

1. Basic Information
2. Employment History
3. Education and Employment
4. Voluntary Self Identification
5. Submitting

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Type of employment*

When could you start work?

Are you 18 years of age or older?*

If you are hired, you may be required to submit proof of age.

How did you hear about us?

If hired, you will be required to furnish proof of your eligibility to work in the U.S.